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OTC > Headache and Musculoskeletal > Flashcards

Headache and Musculoskeletal Flashcards

1
Q

estimate of 1/3 of non rx analgesic use is for

A

headaches

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2
Q

primary headache

A

not associated with underlying illnesses (90% of headaches)

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3
Q

examples of primary headaches

A

episodic and chronic tension-type, migraine, cluster, medication over-use headaches

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4
Q

secondary headaches

A

symptom of underlying condition

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5
Q

examples of secondary headaches

A

head trauma, stroke, substance abuse or withdrawal, bacterial and viral diseases, and craniofacial disorders

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6
Q

tension-type headaches

A

manifests in response to stress, anxiety, depression, emotional conflicts, etc.

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7
Q

episodic tension-type

A

peripheral pain source

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8
Q

chronic tension-type

A

central mechanism, occurs at least 15 days/month for at least 6 months

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9
Q

migraine

A

complex interaction of neuronal and vascular factors involving dysfunction of the trigeminovascular systems. stimulation of the trigeminal sensory fibers in the large cerebral and dural vessels resulting in inflammation, vasodilation, and activation of platelets and mast cells

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10
Q

T/F a medical diagnosis is not needed to self treat migraines

A

false

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11
Q

sinus headache

A

infection or blockage of paranasal sinuses causing inflammation of the sinus walls

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12
Q

medication-overuse headache

A

results from rebound effect after withdrawal of an analgesic that has been used more than two times a week for more than three months and occurs within hours of stopping the agent

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13
Q

agents associated with medication-overuse

A

APAP, NSAIDs, aspirin, caffeine, triptans, opioids, butalbital, and ergotamine

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14
Q

treatment goals for headache

A
  1. reduce severity and alleviate acute pain
  2. restore normal functioning
  3. prevent relapse
  4. minimize side effects
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15
Q

exclusions for self treatment of headache

A
  1. severe head pain
  2. headache longer than 10 days
  3. last trimester of pregnancy
  4. < 8 years of age
  5. high fever or signs of infection
  6. history of liver disease or consumption of three or more drinks/day
  7. secondary headache
  8. no diagnosis of migraine
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16
Q

non pharm treatment

A
  1. relaxation exercises, physical therapy
  2. maintain regular schedule for sleeping, eating, and exercise
  3. ice packs
  4. diet - restrict foods that are triggers
  5. avoid triggers
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17
Q

APAP indication

A

fever or mild to moderate pain

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18
Q

MOA of APAP

A

central inhibition of prostaglandin synthesis via inhibition of COX-1 isoenzyme. Inhibits prostaglandins from sensitizing nociceptors that are initiating pain impulses

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19
Q

T/F APAP has anti-inflammatory benefits

A

false

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20
Q

onset of action for APAP

A

30 minutes, duration is 4 hours

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21
Q

1 cause of acute liver toxicity

A

APAP

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22
Q

adult dose of apap

A

325-500mg q4-6hr

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23
Q

apap max dose at one time

A

1000mg

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24
Q

apap max dose per day

A

4000mg/day

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25
Q

apap max dose for elderly

A

less than or equal to 3000mg/day

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26
Q

apap max dose and warfarin use

A

less than or equal to 2000mg/day

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27
Q

apap max dose with alcohol use

A

less than or equal to 2000mg/day

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28
Q

apap children dose

A

10-15mg/kg q4-6hr (max dose 5 per day)

liquid: 160mg/5mL

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29
Q

adverse effects for apap

A

rash, generally well tolerated

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30
Q

precautions for apap

A

underlying liver dysfunction, more than 3 drinks/day

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31
Q

overdose for apap

A

more than 3 grams per day

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32
Q

antidote for apap overdose

A

N-acetylcysteine or activated charcoal

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33
Q

toxic single dose of apap

A

10-15g

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34
Q

fatal single dose of apap

A

20-25g

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35
Q

MOA of NSAIDs

A

reversible inhibition of COX 1 and 2 enzyme which causes central and peripheral inhibition of prostaglandin synthesis which inhibits prostaglandins sensitize nociceptors to initiate pain impulses

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36
Q

NSAIDs are used as

A

analgesic, antipyretic, and anti-inflammatory

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37
Q

duration of action for ibuprofen

A

6-8 hours

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38
Q

duration of action for naproxen

A

8-12 hours

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39
Q

adult dose of ibuprofen

A

200 to 400mg q6-8 hr

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40
Q

max OTC dose of ibuprofen

A

1200mg/day

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41
Q

ped dose of ibuprofen

A

5-10 mg/kg q6-8hr
liquid 100 mg/5mL
oral drops 40mg/1mL

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42
Q

max dose ped of ibuprofen

A

max 40/mg/kg/day; max 4 doses

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43
Q

naproxen adult dose

A

220-440mg q 8-12 hours

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44
Q

naproxen max adult dose

A

660mg/day

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45
Q

naproxen ped dose

A

not for < 12 years

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46
Q

naproxen max dose in elderly

A

440mg/day

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47
Q

common adverse effects of nsaids

A

dyspepsia, N/V, heartburn, and abdominal pain

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48
Q

nsaids cause damage to the GI mucosa in two ways

A
  1. direct acidic damage to the GI mucosa

2. inhibition of GI prostaglandins synthesis that lines the smooth muscle of the GI tract

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49
Q

boxed warning for nsaids

A

increased risk of CV events (MI and stroke), risk increases with duration of use, higher dose, and patients with CVD risk factors

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50
Q

nsaids contraindicated in

A

treatment of pain in the setting of a CABG or in patient who has undergone CABG

51
Q

1 cause for acute renal failure

A

nsaids

52
Q

GI bleeding risk factors

A
  • older than 60
  • history of peptic ulcer or GI bleed
  • other medications w/ GI bleed risk
  • alcohol use
  • high dose of nsaids
53
Q

pregnancy recommendations

A

apap recommended

54
Q

drug interactions w nsaids

A

aspirin, anticoagulants, antihypertensive, nephrotoxic drugs

55
Q

combo products w aspirin

A

asa with caffeine, and apap (Excedrin)

56
Q

powder formulation of salicylates

A

BC powder or goody powder

57
Q

non-acetylated salicylates

A

doans, nuprin, momentum

58
Q

non-acetylated salicylates vs. aspirin

A

same anti-inflammatory effect but NA is less superior as analgesic/antipyretic

59
Q

moa of aspirin

A
  • irreversible central and peripheral inhibition of COX 1 and 2
  • inhibits platelet aggregation
60
Q

aspirin inhibits COX 1 at

A

low doses (81-325mg)

61
Q

aspirin inhibits COX2 at

A

higher doses (anti-inflammatory drug)

62
Q

onset of aspirin

A

1-2 hours

63
Q

duration of aspirin

A

4-6 hours

64
Q

aspirin metabolized by

A

plasma

65
Q

adult dosing of aspirin

A

325-1000mg q4-6hr

doses 0f 4-6g for anti-inflammatory

66
Q

aspirin dosing for CV protection

A

81-325

67
Q

max otc dose for aspirin

A

4000mg/day

68
Q

max dose aspirin for children

A

not for <16 years

fda says 19

69
Q

adverse effects of aspirin

A

dyspepsia, nv, heartburn, abdominal pain

70
Q

aspirin contraindicated in

A

patients with bleeding disorders and in children

71
Q

other precautions of aspirin

A

h/o of gout or hyperuricemia, bleeding disorder, renal dysfunction

72
Q

toxicity of aspirin

A

headache, dizziness, tinnitus, dim vision, mental confusion, drowsiness, sweating, thirst, nv, diarrhea

73
Q

drug interactions w aspirin

A

warfarin, nsaids, corticosteroids, alcohol, antihypertensive

74
Q

delayed onset muscle soreness

A

begins > or equal to 8 hours after repeated unaccustomed eccentric muscle contraction and is associated with delayed-onset muscle soreness which can last for days

75
Q

myalgia

A

can result from systemic infections (flu, virus), chronic disorders, medications

76
Q

strains

A

caused by stretching or tearing of muscle or tendon. movements that cause a strain involve twisting or pulling. can be caused by acute injury or chronic

77
Q

strain injury of the muscle is caused by

A

eccentric contraction of the muscle while the muscle is lengthening

78
Q

tendons can become strained when

A

their stretch capacity is exceeded

79
Q

tendonitis

A

inflammation of tendon which results from acute injury or from chronic overuse of a body part (carpal tunnel), can also be caused by medications (fluoroquinolones)

80
Q

bursitis

A

inflammation of the bursa (fluid filled sacs located b/t joint spaces) generally from acute injury to the joint or over-repetitive action, which can be worsened at any movement of the structure adjacent to bursa

81
Q

sprains

A

caused by excessive stretching or partial/complete tearing of ligaments. typically occur during physical activity

82
Q

low back pain

A

fifth most likely reason for physician visit; most patients recover within a few days or weeks; considered chronic if longer than 3 months

83
Q

muscle spasm

A

involuntary muscle contractions; muscle cramps are prolonged muscle spasms that produce painful sensation

84
Q

osteoarthritis

A

gradual softening and destruction of cartilage between bones; often referred to as degenerative joint disease and is considered a chronic condition

85
Q

osteoarthritis is caused by

A

genetic, metabolic, and environmental factors; heavy physical activity, repetitive movement, and lifting of heavy weights can aggravate condition

86
Q

treatment goals for muscles

A
  1. decrease the intensity and duration of pain
  2. restore function of affected area
  3. prevent reinjury and disability
  4. prevent acute pain from becoming chronic
87
Q

exclusion for self treatment of musculoskeletal disorders

A
  1. severe pain (> 6/10)
  2. pain that lasts more than 10 days
  3. pain that continues > 7 days after treatment with topical analgesic
  4. increased intensity or change in character of pain
  5. pelvic or abdominal pain
  6. signs of infection
  7. visually deformed joint, abnormal movement, weakness in any limb, numbness, or suspected fracture
  8. pregnancy
  9. < 2 years
  10. back pain and loss of bowel or bladder control
88
Q

non pharm for muscles

A

RICE and continue for 48-72 hours

89
Q

R in rice

A

rest area for 1-2 days

90
Q

I in rice

A

ice asap, should not be applied for greater than 15-20 min and applied 3-4 times daily

91
Q

C in rice

A

compression with elastic support - wrap point most distal from injury and decrease tightness as your rap toward injured area

92
Q

E in rice

A

elevate injured area at or above level of heart for 2-3hours a day

93
Q

heat for muscles only in

A

non-inflammatory condition

must be 48 hours after injury for 15-20 min 3 to 4 times daily

94
Q

thermacare moa

A

topical heat wrap that alleviates pain by increasing blood flow, reducing muscle spasm, and improving stiffness

95
Q

kinds of thermacare wraps

A

back, hip, neck, knee, wrist and hand, shoulder, and lower abdomen

96
Q

how long to apply thermacare

A

up to 8 hours (remove before if pain, itching or burning)

97
Q

transcutaneous electrical nerve stimulation (TENS)

A

therapy for sore, aching muscles, joint pain/ or chronic intractable pain

98
Q

TENS moa

A

alteration of pain transmission and increase in production of natural endorphins

99
Q

TENS use

A

15-30 min up to 3 times daily

100
Q

avoid TENS use in

A

use with internal or attached medical devices

101
Q

pharm treatment for muscles

A

nsaids and apap or topical analgesics

102
Q

types of topical analgesics

A

local analgesic, anesthetic, antipruritic

103
Q

topical analgesics used for

A

temporary relief of minor aches/pains of muscles and joints

104
Q

apply topical analgesics

A

up to 3-4 times daily for up to 7 days

105
Q

moa of counterirritants of topical analgesics

A

pain relief through nerve stimulation and psychological component of smell, warmth, and coolness

106
Q

methyl salicylate products

A

bengay and flexall

107
Q

rubefacient

A

‘hot’ action

108
Q

safety considerations of methyl salicylate products

A
  1. caution if sensitive to aspirin
  2. avoid in children
  3. avoid wrapping or heating area
109
Q

methyl nicotinate products

A

aspercreme heat pain relieving gel, bengay ultra strength relieving patch, icy hot, mineral ice, jointflex pain relieving cream

110
Q

if apply methyl nicotinate over large areas

A

can cause hypotension

111
Q

camphor in low concentrations

A

(.1-3%) depress cutaneous receptors

112
Q

examples of counterirritants of topical analgesics

A

methyl salicylate, methyl nicotinate, camphor, menthol, capsaicin/capsicum

113
Q

camphor in high concentrations

A

(3-11%) stimulates nerve endings

114
Q

safety considerations for camphor

A

keep away from children; ingestion can cause CNS toxicity, seizures, and respiratory depression; infants can have respiratory collapse if applied to nostrils

115
Q

menthol in low concentrations

A

(<1%) depresses cutaneous receptor response (anesthetic)

116
Q

menthol in high concentrations

A

(>1.25%) stimulates response (counterirritant)

117
Q

safety considerations of menthol

A

asthma exacerbation possible; enhances permeability of other topicals

118
Q

capsaicin products

A

capzasin, zostric, icy hot

119
Q

capsaicin is extracted from

A

hot chili peppers (warmth)

120
Q

moa of capsaicin

A

depletes substance P at the nerve ending, which is released in response to stress and injury
- elicits a feeling of warmth initially then burning and tingling sensation

121
Q

t/f capsaicin is effective in relieving pain but not inflammation

A

true

122
Q

applying capsaicin

A

regularly 3-4 times daily for 14 days - 6 weeks

123
Q

topical anesthetics

A

lidocaine (used every 6-8 hours, max 3 applications in 24 hours)

OTC (22 decks)

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