5b: Pain Management Flashcards
4 requirements of NSAIDs
- decrease inflammation
- relieve mild to moderate pain
- reduce fever
- decrease risk of blood clotting
mechanism of NSAIDs
they work by inhibiting the COX enzyme, which is an enzyme that produces prostaglandins
when does production of prostaglandins increase?
when a cell has undergone trauma
are aspirin and acetaminophen NSAIDs?
aspirin – yes
acetaminophen – no
roles of prostaglandins
inflammation, increasing sensitivity of pain receptors, and promoting fever
which COX enzyme should be inhibited for best clinical results?
COX-2
What is the primary and oldest NSAID?
aspirin
uses for aspirin
to manage MSK and joint pain, post surgery pain, prevent clots, treat fever, prevent chance of developing cancer
side effects of NSAIDs
GI hemorrhage or ulceration, increased BP, liver or kidney dysfunction, Reye syndrome
why should aspirin not be taken after a fracture?
it can inhibit bone healing
COX-2 selective drugs compared to non-selective COX inhibitors
(Celebrex) less gastric irritation but more upper respiratory tract infections / associated with heart attack and increased CVA risk
rehab implications for NSAIDs
stomach discomfort is a concern, and patients may ask about different types of pain medications
two goals of drug treatment for RA
decrease joint inflammation and decrease/stop progression of the disease
three categories of drugs to treat RA
NSAIDs, glucocorticoids, and DMARDs
difference between NSAIDs and glucocorticoids in treating RA
NSAIDs have fewer side effects but glucocorticoids reduce inflammation to a greater extent
why is acetaminophen not recommended for RA?
it does not affect the inflammation aspect of RA
why take glucocorticoids and DMARDs together for RA?
DMARDs take a few weeks to take effect, so glucocorticoids can help control pain and inflammation until then (or may be combined throughout entire disease process)
side effects of glucocorticoids
osteoporosis, muscle wasting and weakness, HTN, aggravation of diabetes, glaucoma, cataracts, increased risk of infection
types of DMARDs
antimalarials, gold compounds, nonbiological, biological, tumor necrosis factor inhibitors
reason for combining DMARDs
optimal benefits with 2 or more drugs, lower dose of each, and may provide best results
nutrients in the diet that can benefit RA
fish oil, omega-3 fatty acids, and antioxidants (fruits and vegetables)
nutrient in the diet that can harm RA
meat/protein
is pharmacology the focus of treatment for OA?
No – should focus on nonpharmalogical treatment (PT, weight loss, joint replacements), NOT joint inflammation
rehab implications of RA drugs
glucocorticoids: watch for damage to bone, tendon, muscle, skin breakdown
DMARDs: infection control
