13. Approach To Pain Flashcards
All of the follow are what kind of drugs for pain? Aspirin Ketorolac Indomethacin Ibuprofen Flurbiprofen Naproxen Diclofenac Celecoxib Meloxicam
NSAIDs
2 ways of pain sensation: Tissue damage intiates the releases of local inflammatory mediators causing hyperalgesia and allodynia, and glutamate stimulation of spinal NMDA receptors can cause a secondary hyperalgesia…..
MEOW
Common anti inflammatory indications for NSAIDs include osteoarthritis, bursitis, gout flare, ankylosing spondlitis, dysmenorrhea and MC what you use for daily is?
Headaches
Arachodonic acid AA under pressure produces COX which produces thromboxane which causes vasoconstriction, increased aggregation and is thrombotic, also stimulates prostacyclin which causes vasodilation, dec aggregation and?
Anti thrombotic
COX1 and 2 have the same substrates and products, both have role in inflam and phys role in renal function. Which one is expressed in all tissues all the time, and contributes to response to any pathological stimuli?
COX1
COX2- induced in kidney, and some tissues some times
For cardiovascular risk- all NSAIDs should be used at their lowest effective dose, especially COX2-selective should be AVOIDED in pts with CV risk factors, where NSAID therapy is required for patients at risk of CV complications, what drug is more recommended than NSAIDs?
Naproxen
NSAIDs have contraindications that include chronic kidney disease, active duodenal or gastric ulcer, CV disease, NSAID allergy or ongoing treatment with anticoagulants like?
Warfarin
Aspirin is the NSAID prototype and has 4 major beneficial actions including suppression of inflam, relief of pain, reduce fever and prevent MI stroke due to COX1/2 inhibition, but since those two are inhibited they cause risk of gastric ulceration, bleeding and?
Renal impairment
Aspirin and NSAIDs cause IRREVERSIBLE inhibition of COX which lasts for 8 days, for anti inflam effects doses are much higher compared to anti fever or pain, useful in rheumatoid arthritis and very* effective analgesic and is as effective as what for post op pain?
Opiods
Aspirin due to its anti platelet effects can INC risk of bleeding in pts takin warfarin- discontinue before surgery, by impairing renal function aspirin can cause sodium and water retention, edema and HTN- only see in pt with advanced age, and pre-existing?
Renal dysfunction
Long term Aspirin use may lead to renal papillary necrosis, may cause reye sydrome in kids with chicken pox or influenza, not to be used during labor and delivery, aspirin can cause hypersensitivity reactions in those with asthma rhinitis and nasal polyps- treat with?
Epinephrine *
Non-Aspirin NSAIDs inhibit COX1/2 suppressing inflam, pain and fever, inc. risk of ulcer, renal impair and bleeding all like aspirin, important differences include they INC risk of MI/stroke and are less effective meaning they are?
REVERSIBLE (last 3 days) unlike aspirin which is irreversible
What Non-Aspirin NSAID is for short term management of severe acute pain, usually postop, not for peds and not for minor pain conditions, causes peptic ulcers, GI bleed and can be fatal, *INC risk of bleeding, CV thrombotic events and renal risk?
Ketorolac (post op use)
What Non-Aspirin NSAID exhibits antipyretic and analgesic properties*, indicated for mod to sev rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, painful shoulder, gouty arthritis, have same CV/GI risks, contraind for tx of peri-operative pain post CABG**?
Indomethacin
What Non-Aspirin NSAID is for fast relief of headache, menstrual pain, toothache, pain from inflammation, minor aches and pains in muscles, fever, and contraindicated in pt with active gastric or duodenal ulcer/GI bleeding, liver dz, or renal impairment?
Ibuprofen
Ibuprofen is a NSAID that should be used carefully in pt with head dz and HBP, heart failure and hypertension, with GI tract irritation or hx of ulcer, or in pt with increased risk of renal toxicity such as elderly pt with impaired kidney, SE include dec. appetite, edema and?
Fluid retention
What Non-Aspirin NSAID is a TOPICAL for opthalmic use, analgesic, antipyretic and anti inflam activity, MOA is inhib of COX, used topical for inhibition of intraoperative miosis**?
Flurbiprofen
