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Clin Pod Med Exam III > 28: Non-narcotic Pain Management - Frush > Flashcards

28: Non-narcotic Pain Management - Frush Flashcards

1
Q

what inhibits phospholipase?

A

corticosteroids

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2
Q

what inhibits COX?

A

NSAID

ASA

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3
Q

why COX2 not COX1?

A

COX 2 is responsible for inflammation pathways; COX1 is more physiological functions (side effects)

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4
Q

potential complications of NSAIDs

A
  • GI
  • CV (black box for heart conditions)
  • Renal
  • can exacerbate asthma symptoms (prostaglandins can act as bronchodilators)
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5
Q

GI risk factors with NSAID use

A 
- Concomitant use with: 
ASA(Risk with both nonselective and selective);Other NSAIDs; Corticosteroids; Anticoagulants
- Age >65
- Use of high doses of NSAIDs
- Cardiovascular disease
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6
Q

does COX2 have CV risks?

A
  • Suppresses synthesis of prostacycline leaving Thromboxane A2 production unopposed
  • Excess Thromboxane A2 causes:Vasoconstriction, Platelet aggregation, Thrombosis
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7
Q

why do NSAIDs have renal effects?

A
  • COX 1 maintains GFR
  • COX 2 found in kidneys (Thought to play a role in medullary blood supply, Na+ balance and systemic blood pressure)
  • NSAIDs and COX 2 inhibitors (Shown to increase fluid retention; Increase blood pressure; Can exacerbate CHF)
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8
Q

how do you make an NSAID safer for GI issues?

A

add a PPI

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9
Q 
what do NSAIDs do to the following drugs?
B blockers
ACE i
diuretics
lithium
methotrexate
A

May decrease effect of

  • B blockers
  • ACE inhibitors
  • Diuretics

May increase levels of

  • Lithium
  • Methotrexate

use with cyclosporine can cause nephrotoxicity

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10
Q

warfarin and NSAID?

A

synergistic - can cause increased bleeding

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11
Q

most CV neutral of NSAIDs

A

naproxen (aleve)

- but can affect BP

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12
Q

used for acute gout attacks

A

indomethacin (has high GI side effects)

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13
Q

NSAID that only needs to be taken 1x daily

A

meloxicam

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14
Q

only COX2 selective inhibitor available

A

celebrex

sulfa allergy warning

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15
Q

how do corticosteroids work?

A
  • Help reduce pain and inflammation by inhibiting arachidonic acid production
  • Thus prevents production of leukotrienes and prostaglandins
  • Aids in acute and chronic inflammation associated with pain and also helps with asthma
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16
Q

why do you need to tape people off corticosteroids?

A

If on cortisol chronically physiologic production of cortisol can be decreased through HPA axis

17
Q

indications for steroid injections?

A

Intra-articular

  • Osteoarthritis
  • Traumatic arthritis
  • Capsulitis
  • Sinus tarsitis
Nonartiuclar
Tendonitis
- *DO NOT INJECT AROUND ACHILLES* (doesn't have sheath) 
- Plantar fasciitis
- Neuromas or nerve entrapments
- Ganglion cysts
18
Q

phosphates v. acetate steroid injections

A

Phosphates

  • Water soluble
  • Clear
  • Short acting

Acetates

  • Water insoluble
  • Cloudy
  • Longer acting
  • Can crystallize
  • Should not use in joint injections
19
Q

why is amitriptyline an increased fall risk?

A
  • can cause orthostatic hypotension

- its a TCA

20
Q

why shouldn’t you use ASA with children?

A

potential Reye’s syndrome

21
Q

MOA ASA

A

inhibits platelets

22
Q

when do you need supplementation with steroids?

A

if on 5mg or less no supplementation

for most podiatric procedures, sufficient to give 25mg prior to start of procedure on top of regular dose

23
Q

contraindications to steroid injections

A

absolute: joint sepsis, prosthesis, fracture, bacteremia
relative: joint instability, coagulapthy, celluites, greater than 3-4 injections to area in past year

24
Q

what are the steroid injections most commonly used in podiatry?

A
  • dexamethasone ( 4-16 mg/mL)
  • triamcinolone (10 or 40 mg/mL)
  • beamehtasone ( 3 mg/mL)
25
Q

steroid injections should be mixed with lcoal anesthetic to give immediate relief and reduce injection discomfot

A

1-2 mL of LA with 0.5-1 mL of steroid

26
Q

what is the dosage and use for acetaminophen?

A
  • no anti-inflammatmory properties
  • good fever reducer
  • 325-1000 mg po every 4-6 hrs
  • max dose 4 grams
27
Q

what drugs can you give for neuropathy pain?

A
  • amitriptyline/elavil (TCA)
  • gabapentin/neurontin (antivonvulsant)
  • pregabalin/lyrica (anticonvulsant)
  • duloxetine/cymbalta (SSNRI)
  • tapentadol/nucynta (opioid)
28
Q

NSAID contraindicated in pregnancy

A

diclofenac

29
Q

sulfa allergy

A

caution with celebrex

30
Q

side effects/complications of corticosteroids

A
  • weight gain
  • increased blood glucose levels in diabetes
  • osteoporosis
  • immunosupression
  • decreased wound healing
  • tendon rupture

Clin Pod Med Exam III (13 decks)

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