MSK Flashcards
First line treatment for OA
Non-pharm and pharm
Non-Pharm: physio, assisted devices, splints, prevention of further injury, weight loss, yoga, aquatics
Pharm: topical NSAIDS, then Tylenol
What is the preferred NSAID analgesic with high CV risk?
Naproxen low dose
What is the preferred analgesic with high GI risk?
Low dose celecoxib + gastroprotection
Preferred analgesic for OA (no/low CV or GI risk)?
Low dose NSAID
What is preferred if high GI and CV risk for OA?
Duloxetine or local steroid injections
What is the last line treatment for OA?
Surgery or opioids
Max Tylenol daily dosage in elderly
2-3g
When should NSAIDs be avoided?
Cardiac patients, Nephro kidney patients, and GI risk patients
Which opioid has the best safety profile?
Tramadol
How often can pts receive steroid injections in weight-bearing joints?
3-4x/yr
What controlled substances can an NP not prescribe?
- opium (such as opium and belladonna suppository)
- coca leaves (such as cocaine) and
- anabolic steroids except testosterone (NPs are authorized to prescribe testosterone.)
What is required for the prescription of an opioid?
A PPA - Patient and Provider Agreement, which is a pain management contract signed by pt and prescriber
- states the pt must use only 1 prescriber and 1 pharmacy, will not share meds and will comply with monitoring ie random drug urine screen
What to prescribe for patients at risk of ulcers while receiving long term NSAIDs
Misoprostol is the only anti-ulcer drug proven to be well tolerated and effective
What are some non-pharm options for acute low back pain?
- physical activity as tolerated
- physio
- spinal manipulative therapy
- psychological interventions
- acupuncture (weak efficacy)
- resume normal activities & work as soon as tolerated
- avoid unnecessary bedrest
What are some non-harm for chronic low back pain?
- physical activity as tolerated
- physio
- yoga, tai chi, pilates, nordic walking
First line med for acute low back pain?
Tylenol 500mg q4h
T/F: Celecoxib (Celebrex) is more efficient than NSAIDs?
False: There is no evidence that one NSAID or COX-2 inhibitor (Celecoxib) is more efficient than another
- Celecoxib does show fewer GI side effects than traditional NSAIDs
What is the difference between Tylenol 1, 2 & 3?
Tylenol 1 = acetaminophen
Tylenol 2 = 300 mg acetaminophen, 15 mg caffeine and 15 mg codeine phosphate tablets.
Tylenol 3 = 300 mg acetaminophen, 15 mg caffeine and 30 mg codeine phosphate tablets.
How many days should you use opioids for for acute pain if indicated?
limit for 3-7 days, not indicated for subacute/chronic
What is an adverse effect of muscle relaxants?
Some are sedating, therefore not recommended for chronic use
When would a muscle relaxant be appropriate?
If a spastic component involved and is acute (<4wks) would use: baclofen, cyclobenzaprine, and tinzanidine. Generally avoid benzos
Are cannabinoids recommended for acute pain?
No the evidence does not support it
When would cannabinoids be recommended?
refractory neuropathic pain and refractory pain in palliative care, chemotherapy-induced nausea and vomiting, and spasticity in multiple sclerosis and spinal cord injury after reasonable trials of standard therapies have failed.
If considering medical cannabinoids and criteria are met, the guideline recommends nabilone or nabiximols be tried first.
We never recommend smoked as high bias risk in literature and long-term consequences unknown
What is a tool that can be used when determining whether to order opioids for someone?
Opioid risk tool
