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815 > Chapter 7 - Musculoskeletal (Cut off for Exam 1) > Flashcards

Chapter 7 - Musculoskeletal (Cut off for Exam 1) Flashcards

1
Q

Musculoskeletal Injuries

A
  • Arises muscles, joints, bones, and connective tissues
  • Can be acute from things like sport injuries (tendonitis, sprains, strains) or exacerbated conditions (osteoarthritis)
  • Chronic: pain lasting 3+ months
  • Acute: pain lasting < 4 weeks
  • 100 million+ adults battle chronic pain in US
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2
Q

Tendons

A

Connect bones to muscles, usually stretch and twist, rarely rupture, damaged with hyper extended or overused

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3
Q

Ligaments

A
  • Connect bones to bones,
  • Usually stretch and twist, rarely rupture, damaged with hyper extended or overused
  • More commonly tear or rupture than tendons
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4
Q

Synovial Bursae

A
  • Fluid-filled sac between joint spaces

- Lubrication and cushioning

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5
Q

Catilage

A

-Protective pads between bones in joints and spine

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6
Q

Skeletal/Striated Muscle

A
  • Responsible for contractions

- Houses pain receptors which are stimulated from overuse or injury

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7
Q

Somatic Pain

A
  • Pain impulse from peripheral nocireceptors to CNS by nerve fibers
  • Commonly myofascial (muscle strain) or musculoskeletal (arthritis)
  • Mediated by mechanoreceptor and chemoreceptor
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8
Q

Inflammatory Response

A
  • Edema
  • Erythema
  • Hyperalgesia
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9
Q

Muscle Injury Categories

A
  1. Delayed-onset muscle soreness, overexertion (can last days, peaks in 24-48 hours)
  2. Myalgia (systemic infections, chronic disease, medications)
  3. Strains (injury to muscle or tendon from strange contraction while lengthening)
  4. Tendonitis (inflammation of tendon from acute injury or chronic/repetitive movements)
  5. Bursitis (inflammation of bursa from joint injury or infection
  6. Sprains (common problem with ligaments, three classes
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10
Q

Grade I Sprain

A

Excessive Stretching

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11
Q

Grade II Sprain

A

Partial Tear

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12
Q

Grade III Sprain

A

Complete Tear

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13
Q

Low Back Pain

A
  • 5th most likely reason for physician visit
  • Many risk factors
  • Can have serious causes
  • Chronic if 3 months or more
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14
Q

Osteoarthritis

A
  • Gradual softening and destruction of cartilage between bones
  • Caused by genetic, metabolic, and environmental factors
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15
Q

Musculoskeletal Clinical Presentation

A
  • Pain = common symptom of all categories
  • If limited function of joint, likely a grade II/III sprain
  • Carpal tunnel - lowered ability to feel hot/cold, false feeling of swelling, weak hands, tendency to drop things
  • Osteoarthritis - limits ADLs, pain often referred in proximal muscles due to changed gait or activity
  • Low back pain - nerve pain, sharp pain down one or both legs, limits ability to bend, move, sit, or walk
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16
Q

Musculoskeletal Treatment Based on Severity

A
  • Acute - alarm system to injury from trauma, disease, muscle spasm, or inflammation
  • Chronic - requires PCP assessment before treatment
17
Q

Musculoskeletal Treatment Goals

A
  1. Decreased intensity of pain
  2. Decreased duration of pain
  3. Restoring function to affected area
  4. Preventing re-injury and disability
  5. Preventing acute pain from becoming chronic pain
18
Q

Musculoskeletal General Treatment

A
  • Similar symptoms so similar self-treatment
  • Nonpharmacologic: RICE (rest, ice, compression, elevation)
  • Pharmacologic: Non-Rx oral analgesics and/or topical analgesics for first 1-3 days
  • Same for acute low back pain
  • Chronic back pain requires medical assessment
  • Osteoarthritis - lifestyle changes and use of analgesic (can be a non-Rx), self-treat after diagnosis
19
Q

Musculoskeletal Nonpharmacologic

A
  • Warm up and stretch before physical activity, proper hydration, proper footwear to prevent sport injury
  • Muscle cramps - stretching, massaging, and immediate rest
  • Electrolyte depletion - oral supplementation and fluids
  • RICE: promotes healing and reduces swelling and inflammation from muscle/joint injuries
  • Don’t apply ice/heat directly to skin and for more than 15-20 minutes at a time, max of 3-4 times per day
  • Heat therapy for noninflammatory injury including acute low back pain but NOT osteoarthritis
  • Remove adhesions immediately if you experience burning, itching, discomfort, etc.
  • TENS - approved for pain by alteration of pain transmission and increased endorphin production (Don’t use if preggo, pacemaker, or a child)
  • Proper posture, ergonomic structure use, better-fitting shoes, acupunture, chiropractics, heat therapy, lifestyle changes, and traction massage are also commonly used
20
Q

Musculoskeletal Pharmacologic Options

A
  1. Systemic Analgesics
  2. Topical analgesics
  3. Counterirritants
21
Q

Musculoskeletal Systemic Analgesics

A
  • NSAIDs and APAP are common non-Rx
  • Limit to 10 days of use
  • Seek medical attention if pain lasts longer than this
  • APAP - preferred 1st line for osteoarthritis
  • Recommend topical NSAIDs rather than systemic for chronic use due to severe and prevalent SE (use PPI for chronic use)
22
Q

Musculoskeletal Topical Products

A
  • Local analgesic, anesthetic, antipruritic, and/or counterirritant effects
  • Approved for minor to moderate aches and pains of muscles and joints
  • Adjuncts to nonpharmacologic/pharmacologic therapies
23
Q

Counterirritants

A
  • Produce less severe pain to counter a more intense pain
  • Pain relief from nerve stimulation
  • Produces mild, local inflammatory reaction which decreases perceived pain of actual injury
  • Safe to use in adults and kids 2+ y.o.
  • Temporary relief for minor to moderate aches and sprains
  • Seek medical attention if burning or blistering occurs
24
Q

Trolamine Salicylate

A
  • Topical analgesic
  • Decreases synovial fluid salicylate concentrations lower than aspirin
  • Recommended for adults and kids 2+ y.o. is 10-15% 3-4 times per day
  • No efficacy studies for topical
  • Same CI as salicylates, can be used for hand osteoarthritis
25
Q

Topical NSAIDs

A
  • Topical analgesic
  • Not currently available non-Rx in US
  • If injury close to skin surface, same benefits as oral NSAID without SE
  • Approved for chronic osteoarthritis use
26
Q

Musculoskeletal Combination Products

A
  • Don’t combine drugs from the same category usually
  • Only do so unless the combination is safer and more effective
  • Often add to counterirritants together as long as they’re in different groups
  • Counterirritants + Skin protectants don’t go together (counterproductive)
27
Q

Musculoskeletal Special Populations

A
  • No variability in different ages and races
  • Avoid in kids < 2 y.o.
  • Use caution in those too young to communicate SE they are experiencing effectively
  • Most medications opt for a minimal age of 12 or 18 y.o.
  • Common in preggo, but may have risks due to lack of categorization (see PCP first)
  • Topical camphor - preggo compatible (low risk)
  • Topical salicylates should be avoided in the 3rd trimester due to systemic absorption risk
28
Q

Musculoskeletal Patient Factors

A
  • Consider patient’s medical history and conditions
  • Topicals as adjunct or substitutions of oral medications
  • Category I counterirritant should be recommended at lowest effective concentration
29
Q

Musculoskeletal Patient Preferences

A
  • Dosage form, ease of use, cost, and odor can effect selection
  • Ointment increases absorption but are greasy and usually disliked by patients
  • Rub in topical products (besides patches and solutions)
30
Q

Musculoskeletal Complementary Therapies

A
  • Glucosamine and chondroitin - most common supplement for osteoarthritis
  • Showed no significant reduction of pain and increase in function of joints
  • Not recommended for hip/knee osteoarthritis
31
Q

Assessment of MS Injuries

A
  • Note medications, past medications, and preferences
  • Try to qualify and quantify pain (SCHOLAR-MAC)
  • Numerical pain scales help (Mild: 1-3, Moderate: 4-6, Severe: 7-10, may need medical intervention)
  • Intervene if patient chronically uses non-Rx analgesics
  • Offer education about risks of inadequate treatment and medication overuse
32
Q

MS Counseling

A
  • Tell them dosage, admin. instructions, interactions, self-monitoring techniques
  • In acute pain, administer non-Rx analgesics early and taper off as pain severity allows
  • Tell PCP about new or worsening pains
33
Q

MS Evaluation

A
  • Primary indicator is the patient’s perception of pain relief
  • If pain continues or worsens after 7 days, refer them for further evaluation
  • Lack of return often means successful treatment
  • Those who return with continued swelling, pain, or inflammation - refer for medical evaluation
  • Continued pain could indicate a chronic, potentially debilitating, condition
34
Q

MS Exclusions

A
  • Severe pain
  • Pain that lasts > 10 days
  • Pain that continues > 7 days after treatment with a topical analgesic
  • Increased intensity or change in character of pain
  • Pelvic or abdominal pain
  • N/V, fever, or other signs of systemic infections or disorders
  • Deformed joint, abnormal movement, limb weakness, numbness, suspected fracture
  • Pregnancy
  • <2 y.o.
  • Back pain AND loss of bowel/bladder control
35
Q

Methyl Salicylate

A

-Rubefacient
-Causes vasodilation of cutaneous vasculature which promotes reactive hyperemia, inhibits central/peripheral prostaglandin synthesis
-Hot effect
-Localized and systemic reactions (salicylate toxicity)
-Heat increases absorption
-Do not use in children
-Use caution in patients on anticoagulants
EX: Salonpas, Bengay, Icy Hot

36
Q

Camphor

A
  • Group B
  • Cooling sensation
  • Depresses cutaneous receptors and at high concentrations stimulates nerve endings in the skin, induces relief of pain by marking deeper visceral pain
  • CNS toxicity if ingested which can lead to N/V, seizures, dizziness, headache, delirium, coma, and death
37
Q

Menthol

A
  • Group B
  • Cooling sensation
  • <1%: depresses cutaneous receptor response (anesthetic)
  • > 1.25%: stimulates cutaneous receptor response (counterirritant)
  • Triggers TRPM8 receptor that causes cold sensation that travels along pathway similar to somatic pain sensations from affected muscle or joint
  • Feel coolness followed by warmth
  • ADR: irritation, rash, burning, swelling
  • Ex: Aspercreme, Bengay, Icy Hot, Mineral Ice
38
Q

Methyl Nicotinate

A
  • MOA: vasodilation and elevation of skin temperature

- ADE: Decreased BP, decreased HR, syncope

39
Q

Capsicum Preparation

A
  • Group D for acute and chronic pain
  • Major ingredient of hot chili peppers
  • MOA: Stimulates TRPV1 and depletes of substance P which causes irritation
  • Decreases pain but not inflammation
  • In 2 weeks pain starts to be relieved, but can take 4-6 weeks to fully take effect
  • Must continually use 3-4 times a day

815 (24 decks)

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