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Pharmacy CPS Flashcards > MSK > Flashcards

MSK Flashcards

1
Q

Acute Pain

A

Temporary pain, serving as a warning that something is wrong and usually resolves as healing occurs

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2
Q

Chronic pain

A

Pain that persists for 3 or more months.

Significant emotional distress present

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3
Q

Nociceptive pain

A

Tissue damage often from injury, inflammation, or disease.
Typically acute pain.
May feel throbbing, aching, or sharp.

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4
Q

Neuropathic pain

A

Nervous system damage from peripheral or CNS dysfunction.
Often chronic pain.
Feels burning, tingling, or numb

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5
Q

Nociplastic pain

A

Neural pain despite no evidence of nervous system damage.

Presents similar as neuropathic pain

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6
Q

Cancer pain

A

Presents as both nociceptive and neuropathic

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7
Q

Hyperalgesia

A

increased sensitivity to pain

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8
Q

What is essential to success in pain therapy?

A

Nonpharmacological therapies are most effective treatment

e.g psychological, physical/rehab, device/prodecure, self management, etc.

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9
Q

Factors of pain

A

Biological, psychological, social, and cultural

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10
Q

What pain medications are safe in pregnancy and lactation?

A

P: acetaminophen, methadone, suboxone, nortripyline, (oxycodone, morphine, fent in 1st and 2nd trimesters)
L: acetaminophen, suboxone, nortripyline, morphine, fentanyl, hydromorphine, NSAIDs

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11
Q

Preferred pain agents in impaired renal function

A

Acetaminophen, hydromorphone, oxycodone, methadone, TCAs

Decrease doses of gabapentin, pregabalin, venlafaxine, tramadol

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12
Q

Preferred pain agents in hepatic dysfunction

A

NSAIDs (avoid child pugh C), acetaminophen (prolonged use reduce dose)
Caution with opioids and avoid SNRIs

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13
Q

What pain meds to avoid in geriatrics?

A

Anything that affect the CNS and increase risk of falls, i.e. TCAs, SNRIs, muscle relaxants, opioids, cannabinoids, gabapentinoids)

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14
Q

Why to avoid indomethacin in geriatrics?

A

increased risk of CNS harms

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15
Q

Treatment options for Trigeminal neuralgia

A

Anticonvulsants: CBZ (DOC), gabapentin, lamotrigine, phenytoin
Topical anesthetics: Botox (if CBZ not tolerable)
Drug causes of TN: digoxin, macrobid

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16
Q

Diabetic neuropathy treatment options

A

TCAs, SNRIs, gabapentin, pregabalin, valproate, lamotrigine, SSRIs, capsaicin

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17
Q

Treatment options for post-herpatic neuralgia

A

TCAs, SNRIs (duloxetine), gabapentin, pregablin, divalproex, opioids, capsaicin

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18
Q

Treatment options for post stroke

A

TCAs, lamotrigine

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19
Q

Treatment options for spinal cord injury

A

They all suck but Gabapentin, pregabalin, lamotrigine, strong opioids controversial, ketamine, baclofen for spasm, amitripyline if depressed, valproate not useful

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20
Q

Post mastectomy treatment options

A

Capsaicin, venlafaxine, amitripyiline

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21
Q

Phantom limb pain treatment options

A

Gabapentin, opioids, ketamine, or CBZ or propranolol are also options

22
Q

Complex regional pain syndrome treatment options

A

TCAs and anticonvulsants options but lack data, opioids?, NSAIDs?, bisphosphonates, prednisone, nifedipine

23
Q

Fibromyalgia treatment options

A

Exercise, CBT, aquatic exercise, medical bathing

TCAs, cyclobenzaprine, SSRIs, SNRIs, antiepileptics

24
Q

Treatment for daily chronic headache

A

Amitriptyline, SSRIs, divalproex, topiramate, gabapentin, botox

25
Q

MSK Non OA pain treatment options

A

Non drug TX!
NSAIDs useful in acute
Opioids

26
Q

Osteoarthritis treatment options

A

Acetaminophen, NSAIDs (more effective), duloxetine for knee, intra-articular corticosteroid injection for knee, viscosupplement, opioids

27
Q

Concomitant psychological factors may consider using…

A

Depression: TCA, venlafaxine, SSRI, mirtazapine
Insomnia: TCA, trazodone, mirtazapine
Bipolar: CBZ, divalproex, lamotrigine
Weight gain: topiramate, gabapentin, nortriptyline

28
Q

Adequate trial for TCAs for pain

A

2 weeks at adequate target dose and increase dose every 1-2 weeks
effective in sleep and neuropathic pain

29
Q

Low back pain nonpharm therapy

A

Activity as tolerated, physiotherapy, spinal manipulation, psychosocial intervention, multidisciplinary intervention

30
Q

Pharmacological treatment options in low back pain

A

NSAIDs: effective in acute LBP mod-sev, somewhat effective in chronic LBP
Acetaminophen +/- codeine: option but ? benefit
Opioids: not generally recommended, use for <3 days
Muscle relaxants: possible short term role, <1-2 weeks, mixed evidence and studies do not support chronic use in LBP. Linked with sedation
Antidepressants: Duloxetine for chronic LBP. Other antidepressants if comorbidities. TCAs possible
Anticonvulsants: option if neuropathic

31
Q

A/E of muscle relaxants

A

Drowsiness, impaired cognitive function, falls, dependence, hepatic toxicity with chronic use.

32
Q

Drug interactions of muscle relaxers

A

1A2 inhibitors (cipro), hypotension

33
Q

What is gout?

A

Uric acid crystals (needle like) deposited in joints, nephrons, and tissues
Serum uric acid levels often elevated due to decrease in excretion or increased purine breakdown

34
Q

Causes or risk factors of Gout

A

The 3 D’s
Drugs: ACE/ARBs, acetazolamide, ASA, chemo, cyclosporine, diuretics (loops and thiazides), ethambutol, lead, levodopa, niacin, ritaonvir, tacrolimus
Disease: malignancies, CKD, HTN, obesity, hyperglycemia, hyperlipidemia, surgery, trauma
Diet: purine rich foods (alcohol, fish, red meat)

35
Q

Gout flare

A

Intense pain –> redness, heat, swelling, more often at night and in the big toe

36
Q

Stages of Gout

A

1: Asymptomatic Hyperuricemia: elevated uric acid without sx (<25% develop gout and typically does not require drug tx)
2: Acute gouty arthritis: wuick onset, usually one joint, may self resolve within 14 days
3: Intercritical gout: sx free period but disease may progress
4: Chronic tophaceous period: progression to tophi, bony erosins, deformations, nephropathy, kidney stones

37
Q

Non pharm for gout

A

Diet (low cal), lifestyle like weight loss, smoking cessation, exercise, etc. Rest, elevate, ice limb, (heat dissolves crystals but increases inflammation)

38
Q

Treatment for acute attack of gout

A

Rapid tx is key (<24 hr) after onset to decrease inflammation and pain.
Colchicine, NSAIDs, or corticosteroids all 1st line, start at high dose and taper
Combo may be appropriate if severe
Avoid adjusting allopurinol

39
Q

Maintenance/prophylaxis gout therapy

A

Prevent flares and treat when sUA levels over 800, 2 or more flares per year. chemo, advanced damage, CKD
Allopurinol 1st line and waiting 1-2 weeks post flare is reasonable as weak evidence during (start low to avoid A/E and can prophylax with colchicine or NSAID (not ASA) will titrating for 3-6 months to prevent flares

40
Q

NSAIDs MOA for Gout

A

Cyclooxygenase inhibitors to decrease pain and inflammation

Indicated for acute attack or when initating allopurinol

41
Q

Colchicine MOA for Gout

A

Decrease urate crystal deposition and pain/inflammation

Indicated for acute gout attacks, prophylaxsis, or when initating allopurinol

42
Q

Corticosteroids MOA for Gout

A

Decrease pain and inflammatory response, effectvie for gout but not officially indicated
Useful if CI to NSAIDs

43
Q

Xanthine Oxidase Inhibitor MOA

A

Allopurinol, Febuxostat
Decrease uric acid production
Indicated for prophylaxis

44
Q

Colchicine A/E

A

N/V/D (limit to <3 tabs on day 1, then 1-2 tabs/day will decrease), rash, alopecia
Serious: neutropenia, myopathy, rhabdo

45
Q

Colchicine CIs

A

Blood dyscrasias, solid organ transplant, ?dialysis

Caution: renal function (decrease dose)

46
Q

Colchicine DIs

A

Cyclosporine (increase myopathy), P-gp, 3A4 (ketoconazole, macrolides, verapamil, etc)

47
Q

Allopurinol A/Es

A

Rash, diarrhea, hypersensitivity syndrome, SJS

Precaution: renal dysfunction, acute gout, liver dysfunction

48
Q

Allopurinol DIs

A

rash when used with penicillins, antacids, thiazides, ACEi

Azathioprine, cyclophosphamide, theophylline, warfarin

49
Q

How to decrease A/E of allopurinol?

A

Start low and go slow with titration

Increase by 100mg Q2-4W, half that dose if elderly

50
Q

NSAIDs A/E, CIs, DIs

A

A/Es: GI upset, CNS effects with indomethacin (headache, drowsy, confusion)
CIs: decrease in renal, GI ulcer, HF, transplant (can use in CKD state 1 and 2)
Caution: CVD (celecoxib CI)
DI: lithium, ACEi/ARBs (increase K+)

51
Q

Corticosteroids A/E, DIs

A

A/E: rare in short term, caution in long term. Insomnia, increase in BP/BG, GI upset, mood changes. Serious: edema/HF.
Caution: infections, immunosuppression
DIs: vaccines

52
Q

Febuxostat A/Es, DIs

A

A/E: increase in LFTs, nausea, arthralgia, rash. Serious: HF/MI

Pharmacy CPS Flashcards (27 decks)

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