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Pharmacotherapeutics - Final > MSK/Pain > Flashcards

MSK/Pain Flashcards

1
Q

pharm options for MSK pain

A

NSAIDs
non-opioid analgesics
antiseizure
antidepressants
opioid analgesics
local anesthetics

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2
Q

5 invasive therapies for MSK pain

A

trigger point injxns
joint injxns
regional nerve blocks
epidural injxns
surgery

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3
Q

what pain med inhibits the synthesis of PG in the CNS

A

APAP

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4
Q

APAP works __ to block pain impulse generation

A

peripherally

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5
Q

does APAP inhibit platelets

A

not really

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6
Q

is APAP antiinflammatory

A

not really

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7
Q

when would you use 650 mg of APAP

A

arthritis

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8
Q

available doses for asa

A

81 mg - baby
325
500 mg - extra strength
650 mg - arthritis

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9
Q

what’s the max dose of APAP

A

4 g daily

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10
Q

what is the actual safest dose of apap

A

3
esp in elderly

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11
Q

apap is recommended for what uses

A

antipyretic
pain
-OA
-migraines
-MSK pain
-pregnant pain

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12
Q

antitode for apap

A

n-acetylcystine (mucomyst)

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13
Q

what pain med works by reducing PG and thromboxane A2 synthesis

A

salicylates - ASA

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14
Q

does asa inhibit platelet fxn

A

yes!
irreversibly fo’ life bro –> interferes w. hemostasis and prolongs bleeding time

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15
Q

use caution w. ASA in what 4 conditions

A

GI injury/upset
renal injury
viral syndromes in peds
asthma

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16
Q

risk of using ASA in viral syndrome w. peds

A

reye syndrome

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17
Q

how much ASA can precipitate an asthma attack in asa sensitive pt’s

A

single dose!

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18
Q

asa is mc recommended for what 3 conditions

A

anticoagulation
antipyresis
pain
-OA
-migraines
-MSK

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19
Q

non selective NSAIDs inhibit __ (2)

A

cox 1
cox 2

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20
Q

what are the non selective NSAIDs (6)

A

ibuprofen
naproxen/naproxen sodium
indomethacin
etodolac
diclofenac
sulindac

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21
Q

what is the only COX-2 inhibitor

A

celecoxib

only one!

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22
Q

NSAIDs are mc used for what conditions

A

antipyresis
anti-inflammatory
pain
-dysmenorrhea
-migraine/tension ha
-MSK pain/strain/sprain

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23
Q

NSAIDs are not recommended for what conditions (6)

A

fx pain
pregnancy
PUD
renal dysfxn
bleeding d.o
uncontrolled HTN

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24
Q

NSAIDs should be used but w. caution in (2)

A

current n/v
GERD

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25
Q

what is the topical NSAID

A

diclofenac sodium (voltaren gel)

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26
Q

is voltaern gel available OTC

A

yes

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27
Q

benefit of voltaren gel over orals

A

less s.e

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28
Q

topical anesthetics (2)

A

lidocaine - patches, gel, cream, spray
8% capsaicin patch (qutenza)

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29
Q

what has capsaicin patch (qutenza) been approved to treat

A

postherpetic neuralgia

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30
Q

parenteral NSAID

A

ketorolac (toradol)

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31
Q

mc at home dose of ASA

A

325 mg

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32
Q

t/f: all NSAIDs increase CV risk

A

t!

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33
Q

celecoxib has less __ side effects than non selective NSAIDs

A

GI

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34
Q

s.e of ketorolac (toradol)

A

aki
severe GI toxicity (particularly in elderly)

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35
Q

why doesn’t jaynstein like toradol

A

case reports of patients in every age group developing ARF after a single IM dose

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36
Q

per Jaynstein, max dose of toradol

A

30 mg
no benefit of going any higher

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37
Q

when can you give po toradol

A

only if it’s been given IV or IM first

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38
Q

toradol is mc recommended for

A

op relief of pain/inflammation from:
migraine
renal colic (but contraindicated in aki!)

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39
Q

what must you check before rx’ing toradol

A

renal fxn

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40
Q

s.e of nsaids (4)

A

exacebation/development of CHF
elevated bp/HTN
renal failure
hepatotoxicity
asthma exacerbation/anaphylaxis
platelet inhibition -> GIB, ulceration, perforation. PUD, etoh, advanced age

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41
Q

pt’s taking ASA for cardioprotection should not take __ bc it can interfere w. antiplatelet action

A

ibuprofen

42
Q

asa __ inhibits platelets
ibuprofen __ inhibits platelets

A

asa: irreversibly
ibuprofen: reversibly

43
Q

what 2 nsaids are used for chronic conditions to get pt’s off more commonly used ones

A

meloxicam
diclofenac

44
Q

what does recent research show regarding cv risk w. celebrex

A

it’s prob about the same as other NSAIDs

45
Q

antidote for nsaid toxicity

A

none!

46
Q

6 strong opioids

A

fentanyl
hydromorphone
methadone
morphine
oxycodone
oxymorphone

47
Q

3 weaker opioids

A

hydrocodone
codeine
tramadol

48
Q

jaynsteins choices for opioids

A
  1. vicodin (hydrocodone + apap)
  2. percocet (oxycodone + apap)
49
Q

do opioids have a ceiling for analgesic effects

A

no! they’ll just keep feeling better until they stop breathing

unlike nsaids

50
Q

what 3 opioids contain apap

A

vicodin
vicoprofen
percocet

caution w. these

51
Q

2 names for oxycodone

A

percocet
oxycontin

52
Q

oxycodone is only available __

A

po

53
Q

t/f: po oxycodone is more potent than oral morphine

A

t!
and oral codeine

54
Q

what is jaynstein’s last line opioids choice

A

dilaudid

very coveted by people w. SUD

55
Q

what increases release of fentanyl patches

A

heat
high fever

56
Q

what must you do before prescribing fentanyl patch

A

d.c oral

and vice versa

57
Q

fentanyl can become toxic when combined w. what drugs

A

CYP3A4 inhibitors -
ex ketoconazole (nizoral), clarithromycin (biaxin)

58
Q

what 2 opioids does jaynstein hate bc some people don’t metabolize them and some people are super metabolizers

A

codeine
tramadon’t

59
Q

vicodin, lortab, and norco are all

A

hydrocodone

60
Q

why does jaynstein hate tramadol

A

8 black box warnings
it IS an opioid
lowers sz threshold
non metabolizers vs super metabolizers
associated w. withdrawal and overdoses
SSRI and SNRI activity –> many ddi’s

61
Q

t/f: tramdol is associated w. fewer withdrawals and overdoses than other opioids

A

f!

62
Q

adverse effects of opioids (8)

A

constipation
sedation
n/v
pruritis
hallucinations
confusion/delirium
myoclonic jerking
respiratory dpn

63
Q

antidote for narcotics

A

naloxone (narcan)

64
Q

do not go over __ mme’s when prescribing opioids

A

30

65
Q

mainstay of tx for neuropathic pain syndromes

A

antidepressants
anticonvulsants

although most are not approved for these

66
Q

antidepressants and anticonvulsants are commonly used to treat what 5 pain conditions

A

postherpetic neuralgia
diabetic neuropathy
fibromyalgia
complex regional pain syndrome
phantom limb syndrome

67
Q

t/f: antidepressant/anticonvulsant combo increases analgesic effects

A

t!

68
Q

name 3 TCAs

A

amitriptyline
nortriptyline
imipramine

69
Q

TCAs are more effective than SSRIs for treating what type of pain

A

neuropathic

70
Q

what SNRI has been shown to provide many analgesic benefits of older antidepressants but w. fewer side effects

A

duloxetine (cymbalta)

71
Q

gabapentin is effective for what 2 types of pain

A

neuralgia
DM neuropathy

NO evidence for other types of pain

72
Q

5 adverse effects of gabapentin

A

dizzy
somnolence
edema
wt gain
ABUSE!

73
Q

pregabalin (lyrica) is approved for what 3 conditions

A

postherpetic neuralgia
DM neuropathy
fibromyalgia

74
Q

s.e of pregabalin

A

same as gabapentin, but no abuse

75
Q

what type of pain would you prescribe carbamazepine (anticonvulsant) for

A

trigeminal neuralgia

76
Q

does jaynstein like lamotrigine

A

no!
recent studies have shown it’s less effective
can cause rash and SJS

77
Q

what type of pain might you prescribe sodium valproate and topiramate for

A

migraine prophylaxis

78
Q

what may enhance the analgesic effect of apap, ASA, or ibuprofen

A

caffeine

79
Q

what may enhance analgesic effect of opioids in post op and cancer pain AND reduce n/v

A

hydralazine

80
Q

what is the use of corticosteroids in adjuvant pain meds

A

may produce analgesia in inflammatory diseases or tumor infiltration of nerves

81
Q

what alpha 2 agonist may improve pain and hyperalgesia

A

clonidine

82
Q

medical marijuana has been shown to be effective for what 2 types of pain

A

MS
central neuropathic pain

83
Q

moa for muscle relaxants

A

block transmission thru NMJ at nicotinic receptors -> decrease skeletal muscle tone

84
Q

indication for muscle relaxants in MSK pain

A

only if spasms are present

jaynstein doesn’t really like
if you you have to prescribe, use short doses

85
Q

what’s the problem w. prescribing muscle relaxants w. opioids

A

meets criteria for conscious sedation

86
Q

which muscle relaxant causes the most somnolence, dizziness, and cognitive slowing

A

cyclobenzaprine (flexeril)

doesn’t really work - just causes pt’s to care less

87
Q

flexeril (cyclobenzaprine) PLUS __ is a huge no bc it lowers sz threshold

A

tramadol

88
Q

jaynstein’s 2 go to muscle relaxants

A

metaxalone (skelaxin)
baclofen

less drowsiness/cognitive effect

89
Q

which muscle relaxant is associated w. ataxia, agitation, insomnia, tachycardia, and withdrawal symptoms

A

carisoprodol (soma)

90
Q

only IV muscle relaxant

A

diazepam (valium)

high abuse potential

91
Q

least sedating/cognitive effect muscle relaxer

A

methcarbamol (robaxin)

92
Q

which muscle relaxants are safe for pregnant pt

A

none!

93
Q

what are very efficacious drugs for chronic pain that are coming down the pipeline

A

methadone
suboxone

94
Q

what 2 drugs should be first choice for all chronic pain

A

methadone
suboxone

95
Q

what was our plan for 40 yo m w. chronic lb who failed supportive tx

A

lidocaine patches/voltaren gel
gabapentin

96
Q

muscle relaxants should NOT be used for what type of pain

A

chronic

97
Q

what was our plan for 56 yo f w. chronic pain syndrome on daily opiates and muscle relaxers

A

evaluate for suboxone/methadone MAT tx

98
Q

what was our plan for the 30 yo f w. migraines w.o aura

A

menstrual migraines ->
nsaid dosing 2-3 days prior to menses
Mg
zomig (triptan)

99
Q

jaynstein’s go to triptan

A

zomig

100
Q

what 2 meds are associated w. best evidence for prevention of menses migraines

A

Mg
estrogen

Pharmacotherapeutics - Final (6 decks)

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