General management Flashcards
when should the maximum dose of paracetamol be reduced to 3g per day
risk factors for hepatoxicity
old age
poor nutrition
alcoholism
what is the action of an NSAID
COX inhibitor - mainly COX 2 but some COX 1 inhibition too
what do COX1 and COX2 enzymes do
COX-1 is expressed in most tissues and controls
Platelet aggregation
Renal blood flow autoregulation
GI protection
COX-2 is mainly found in inflammatory cells, and is induced by TNF-alpha and IL-1, its roles are to:
Sensitise nocireceptors to inflammatory mediators such as bradykinin
Sensitises afferent pain receptors in the dorsal horn medially
what are potential complications of chronic NSAID use
Dyspepsia and gastric ulceration
Bronchospasm – especially in asthmatics
Renal insufficiency
Cardiotoxcicity
Decreased platelets
Skin reactions
Increased thromboembolism risk (no inhibition of thromboxane production)
what are absolute contraindications for NSAIDs
severe heart failure
history of GI bleeds/ulceration
if you have to prescribe an NSAID for a patient with a high CV risk which one should you pick
Naproxen
what should always be coprescribed with an NSAID
omeprazole
what are coxibs and when are they used
COX-2 Selective inhibitors
thrombocytopenic or upper GI bleed patients
Still need PPIs coprescribed
what examples are there of non-drug analgesia
Splinting – effective in trauma
Cold therapy – effective in joints post surgery
TENS
Acupuncture
CBT
what are examples of DMARDS
Methotrexate
Sulfasalazine
Penicillinamine
Hydroxychloroquine
Gold compounds
what are the widespread side effects of chronic glucocorticoid use
Infection/poor wound healing
Peptic ulceration
Acute adrenal insufficiency
Cushings syndrome
Diabetes
Avascular necrosis
Psychological effects
Intrascapular fat pad ‘buffalo hump’ development
what must be coprescribed with steroids
PPI
calcium supplements/Vit D supplements +/- bisphosphonates
what is the limit for intraarticular injections of a drug
every 2 months minimum, in practice done every 3/4 months
what are typical non pharmacological treatments for MSK disease
Education
Reduces pain and disability
Reduces healthcare costs
Can take the form of a one on one discussion, written literature, or classes
Physiotherapy
Aerobic training can help with sleep, improve mobility and reduce pain
Local strengthening exercises can increases the musculature around a joint, allowing more ‘cushioning’ to help with pain and mobility
Reduction of adverse mechanical factors
Pacing activities relating to functional ability
Shock absorbing footwear can reduce impact loading
Contralateral walking sticks take loads off damaged joints
Physical treatments
Local heat/cold for temporary relief
Simple aids to help with ADLs
Coping strategies
Relaxation/distraction techniques have been shown to be important to help reduce pain
