31- Medication Flashcards
Why do ortopedists treat pain more frequently than other specialists?
Because for the majority of musculoskeletal conditions, pain is the chief complaint
When are opioids are used to treat pain?
Acute, severe pain-such as postoperative pain
What is the most commonly used opioid anagesic?
Morphine (codeine, hydrocodone, oxycodone, meperidine, and fentanyl are used too)
What is the method of delivery of opioids such as morphine?
orally, rectally, intramuscularly or intravenously
What has been the traditional approach to postoperative pain control with opioids?
On-demand intramuscular opioid delivery (in which a pt must report pain and request medication)
What is patient-controlled analgesia (PCA)?
It’s a method to deliver any of several intravenous or epidural opioids via a pump that is controlled by the patient; the pump can be regulated to minimize the likelihood of overdose or respiratory depression
Why do patients like PCA’s?
deliver any of several intravenous or epidural opioids via a pump that is controlled by the patient; the pump can be regulated to minimize the likelihood of overdose or respiratory depression
When can pt’s be swtiched to oral analgesics from parenteral meds?
If a patient is expected to have significant pain at a continuous level for several days, a longer-acting oral opioid can be administered to permit once- or twice-daily dosing; this reduces the chances of the analgesics reaching a subtherapeautic concentration.
Why are NSAIDS and opioids used together in synergy?
It allows the use of a lower opioid use
How is acetaminophen different than NSAIDs?
Acetaminophen has analgesic and antipyretic properties, it has no proven anti-inflammatory effects and does not reduce platelet aggregation as does NSAIDs.
What is Tramadol used for?
Tramadol effectively controls pain resulting from postoperative surgical trauma and malignant/non-malignant disease states
All NSAIDs inhibit prostaglandin formation by blocking what enzyme?
Cyclooxygenase (COX)
What does COX-1 do?
present in most bodily tissues (including platelets and GI mucosal tissues) and serves as a “housekeeping” enzyme to form protective prostaglandins.
What does COX-2 do?
not present in most tissues unless induced in response to inflammation; it is responsible for the formation of prostaglandins that contribute to pain and inflammation.
How can NSAIDS cause HTN?
NSAIDs also can adversely affect blood pressure, sometimes through fluid retention, or can be a primary cause of hypertension because of adverse effects on the kidneys.
Why are antidepressants sometimes used to treat atypical musculoskeletal pain?
they seem to have analgesic effects in addition to their function as antidepressants
Why are anticonvulsants sometimes used to treat atypical musculoskeletal pain?
been found to be helpful in treating pain that is neurogenic in nature, presumably through a mechanism that is similar to their anticonvulsant properties
When are anxiolytics used?
used alongside analgesics to alleviate anxiety often associated with painful conditions or surgery
What is Viscosupplementation?
the intra-articular injection of hyaluronic acid products to treat pain associated with osteoarthritis of the knee for only a short time.
How can diarthrodial joint injections be diagnostic?
pain relief from an intra-articular injection- even if only temporary- strongly suggests that the painful pathology is intra-articular rather than peri- or extra-articular.
How can diarthrodial joint injections be therapeutic?
The therapeutic effect of these injections is variable, depending on the joint, the etiology of disease, and associated rehabilitative interventions.
What are periarticular injections used for?
treatment of bursitis
Which drugs are used in periarticular injections?
Most corticosteroid injections are given in conjugation with short- and long-acting local anesthetics; to provide immediate relief and minimize the burning sensation
What drugs are used for intraarticular injections?
Corticosteriods (typically given w/ an anesthetic) & Hyalectin
Why are tendon sheath injections not commonly done in the achillies tendon?
Achilles tendon and anterior tibial tendon ruptures have been reported after corticosteroid injections to those structures
Why are corticosteroids given in emergent orthopedic situations?
Corticosteroids are also used in the emergency setting to decrease the swelling associated with spinal cord trauma. If given within 8 hours of spinal cord injury, high-dose intravenous steroids have been shown to help lessen the severity of the injury. They are even more effective if given within 3 hours of injury.
How do Symptom-Modifying Antirheumatic Drugs (SMARDs) treat RA?
consists primarily of NSAIDs and oral steroids; this class is used to decrease pain and inflammation quickly and to suppress chronic inflammation however they do not affect disease progression or avert the longterm destructive sequelae of RA
How do Disease-Modifying Antirheumatic Drugs (DMARDs) treat RA?
comprise a class of drugs that includes a number of agents with dissimilar mechanisms of action and includes many of the drugs formerly classified as “slow-acting,” “second-line,” or “remittive agents” for the treatment of RA; these drugs work to blunt the immune response and slow or halt the destructive effects of inflammatory arthritis. Three examples are Leflunomide (a dihydroorotate dehydrogenase inhibitor), etanercept (a tumor-necrosis factor inhibitor), and methotrexate (mainstay in RA therapy).
What are the adverse effects to corticosteroid use?
interference with insulin fxn and lipogenesis, promotion of osteoporosis, edema, HTN, hypokalemia, poor skin wound healing, susceptibility to infections, cataracts, glaucoma, ulcers, and pancreatitits
What are the 3 common areas of osteoporotic hip Fx’s?
Spine, hip, and wrist
What are the the non-pharmaceutical preventions to osteoporosis?
Weight-bearing exercise, smoking cessation, good nutrition (especially sufficient nutritional intake of calcium and vitamin D), and avoidance of excess alcohol intake
What is the primary primary reason for bone loss in women who are within 5 years of menopause?
Estrogen is primarily responsible for bone loss.
How does calcitonin inhibits bone resorption?
t inhibits bone resorption through a direct inhibition of osteoclasts, which have a high affinity for calcitonin.
How do bisphosphonates inhibit bone resorption?
by interfering with osteoblast ruffled border membranes.
What is the risk of DVT in orthopedic surgery?
Patients undergoing major orthopaedic surgery on the lower extremeties have a higher risk for the development of deep venous thrombosis (DVT) or pulmonary embolism (PE) than any other group of surgical patients, and those undergoing joint replacement or surgery for pelvic trauma are at greatest risk
What are the non-pharmacological approaches to prophylaxis of thrombin embolism?
Mobilization, compressive stockings, compressive devices, alterations in anesthesia technique and preop collection of autologous blood
What is the only oral anticoagulant approved by the FDA for thromboprophylaxis?
Warfarin
How does Warfarin work?
It works by reducing the synthesis of vitamin K-dependent clotting factors II, VII, IX, and X in the liver; it does not have immediate effect on clotting because the body’s supply of these factors are not depleted for at least 8 hrs
How do low-moleculer weight heparin products work?
by binding to antithrombin-III and catalyzing its inactivation of factor Xa
which thromboprophylactic agent is particularly useful in hypotensive epidural anesthesia?
Aspirin
What are the indications for prophylactic antibiotics in orthopedic surgery?
Antibiotics are used in most surgeries especially whenever hardware is implanted because infected artificial joint prostheses result in such severe morbidity that even small decreases in the rate of infection provide a very meaningful advantage
What is the critical window for prophylactic antibiotics in orthopedic surgery?
2-hour period before surgery is the critical window
What is the antibiotic of choice for clean orthopedic cases?
For “clean” cases (those w/o prior infection or skin breakdown), most surgeons choose first-generation cephalosporins for prophylaxis
How do 1st generation cephalosporins (like cegazolin sodium) work?
Its action blocks the transpeptidation of peptidoglycan and thereby inhibits bacterial cell-wall synthesis, it also activates autolytic cell-wall enzymes, resulting in bacterial death
How long are long post-op prophylactic antibiotics used?
For joint replacement procedures in which bone or joint is exposed, antibiotics should be started preoperatively and continued for 24-48 hours.
