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Musculoskeletal System > Muscle Pain Pharm > Flashcards

Muscle Pain Pharm Flashcards

1
Q

What are the most common analgesics for muscle pain?

A

NSAIDs & Paracetamol

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2
Q

What are 5 contraindications of NSAIDs?

A

1) Kidney impairment
2) Heart failure
3) GI ulcer/bleeding
4) Bleeding disorders
5) Systemic corticosteroids/ antiplatelet/ anticoagulations
6) 3rd trimester

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3
Q

How should NSAID choice be altered for a px at risk of renal toxicity?

A

AVOID all NSAIDs
- just maintain hydration and avoid hypovolemia

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4
Q

How should NSAID choice be altered for a px at risk of CVS toxicity?

A

Only celecoxib or ibuprofen
- limited to <6days
- if cannot NSAID → paracetamol alone

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5
Q

How should NSAID choice be altered for a px at risk of GI toxicity?

A

Avoid non-selective NSAIDs
- use COX2 selective w caution (eg. celecoxib)
- co-pharmacy with GI protectant (eg. PPI)

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6
Q

How should NSAID choice be altered for a px at risk of NSAID-related bronchospasm/pseudoallergic rxn?

A

Avoid non-selective NSAIDs
- use COX2 selective w caution (eg. celecoxib)

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7
Q

What is the triple whammy in NSAID pharmacology?

A

NSAID + Diuretics + ACEi → ↑↑↑AKI

NSAID inhibit COX → ↓prostaglandins → Afferent arteriole constriction → ↓renal blood flow

Diuretics → ↓blood volume

ACEi → prevent efferent arteriole contriction → cannot maintain glomerular BP

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8
Q

When should paracetamol be used in caution?

A

1) Hepatic dysfunction/alcohol abuse
2) Underweight/cachectic/frail

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9
Q

What is the main risk in paracetamol overdose?

A

Hepatotoxicity

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10
Q

Alternating paracetamol and ibuprofen improves _________ while combining them improves _____________.

A

Alternating → prolong antipyretic

Combined → ↑analgesia

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11
Q

True or false:
Paracetamol is commonly used to relief muscle pain via its anti-inflammatory effects.

A

False.
For anti-pyretic and analgesic
- NOT anti-inflammatory at clinical doses

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12
Q

What is the moa of tramadol?

A

1) Weak opioid
2) Serotonin-norepinephrine reuptake inhibitor (SNRI)

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13
Q

When is tramadol prescribed for muscle pain?

A

Moderate to severe pain in combination w NSAID or paracetamol

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14
Q

What are 2 AEs of tramadol?

A

1) Constipation, nausea, vomiting
2) Respiratory depression
3) Dependence

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15
Q

What is the most important principle when prescribing opioid analgesics to prevent dependency?

A

Use lowest effective dose of weakest effective opioid for shortest duration
- ensure px is well-educated on use, storage and risk of AEs

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16
Q

True or false:
Opioid combinations are often more effective than NSAIDs for pain associated with acute inflammation?

A

False.
NSAIDs are often more effective than Opioid combinations for pain associated with acute inflammation?

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17
Q

What are 4 AEs of opioid analgesics?

A

1) GI effects
2) Hormonal effects
3) Depression
4) Respiratory effects
5) OD and death
6) Falls and fractures
7) Sedation/drowsiness → accidents
8) Tolerance/dependency
9) Hyperalgesia

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18
Q

What are 4 risk factors for opioid analgesics?

A

1) CNS depressants (eg. alcohol, benzodiazepines, anti-depressants)
2) Comorbidities (eg. mental health conditions)
3) Renal insufficiency
4) Hepatic insufficiency
5) >65 y/o
6) Prenancy
7) FHx of substance use disorder
8) Other opioids

19
Q

Of the muscle relaxants,
__________ is used for acute muscle pain while ______________ are reserved for subacute/chronic/refractory muscle and neuropathic pain.

A

Acute muscle pain → Orphenadrine

Subacute/chronic/refractory muscle and neuropathic pain → Benzodiazepines/GABA analogues

20
Q

What is the moa of orphenadrine?

A

Central muscle relaxant:
1) Muscarinic receptor antagonist
- tertiary amine → crosses BBB well → muscarinic receptors in basal ganglia

2) H1 antihistamine
3) NMDA receptor antagonism
4) NE and Dopamine reuptake inhibitor
5) Na-channel blocker

21
Q

What are 4 AEs of orphenadrine?

A

Common:
1) Nausea and vomiting
2) Flushing
3) Dilated pupils
4) Xerostomia

Higher doses:
5) Tachycardia
6) Ataxia
7) Nystagmus
8) Drowsiness
9) Delirium
10) Agitations
11) Visual hallucinations

22
Q

When should orphenadrine be used with caution?

A

1) Other CNS sedatives
2) 1st gen antihistamines
3) Anticholinergics
4) Antiparkinsonian drugs

23
Q

What is the moa of benzodiazepines (eg. diazepam)?

A

1) Allosteric modulators or GABAA receptors→ ↑freq. of Cl channel opening ↑potency of GABAnergic neurotransmission

2) Suppress brain reticular activating system

3) ↑inhibitory neurotransmission

24
Q

What are 3 indications for benzodiazepines?

A

1) Muscle relaxant
2) Sedative/hypnotic
3) Anxiolytic
4) Anti-epileptic for status epilepticus
5) Induction of anaesthesia

25
Q

What are 2 AEs of benzodiazepines?

A

1) Drowsiness/impaired judgement/↓motor skills

2) Tolerance and high potential for dependance

3) PD DDI with other CNS depressants

26
Q

What is the moa of of Baclofen?

A

CNS GABAB receptor specific GABA analogue → ↓tonic neural stimulation to muscles

27
Q

What are 2 indications of baclofen?

A

1) Skeletal muscle spasms and/or pain
- usually in combination with NSAID or paracetamol
- should be used temporarily

2) Spasmolytic in px with MS or spinal cord lesions

28
Q

What are 2 AEs of Baclofen?

A

1) Sedation, weakness, CNS effects
2) Withdrawal syndrome (with abrupt cessation)
- hyperthermia, pruritus, ↑spasticity

29
Q

What is the moa of Gabapentinoids (eg. Gabapentin, pregabalin)?

A

GABA analogues but act at voltage-gated Ca channels → ↓tonic neural stimulation to muscles

30
Q

What are 3 indication for Gabapentinoids (eg. Gabapentin, pregabalin)?

A

1) Neuropathic pain
2) Chronic pain refractory to other treatments
3) Anti-epileptic for partial seizures

31
Q

What are 2 AEs of Gabapentinoids (eg. Gabapentin, pregabalin)?

A

1) Somnolence, dizziness, ataxia
2) Renal elimination w/o metabolites → heavily dependent on renal f(x)

32
Q

What is the main indication for adjucts for muscle pain?

A

In combination with analgesic for subacute/chronic/refractory muscle and neuropathic pain

33
Q

What is the moa of topiramate?

A

Reduces tonic neural stimulation to muscles by:
1) Inhibits excitatory neurotransmission
- block AMPA subtype glutamate receptors
- block voltage-sensitive Na channels

2) potentiate inhibitory GABAnergic neurotransmissioon

34
Q

What are 2 indications for Topiramate?

A

1) Chronic neuropathic pain
2) Anti-epileptic for partial seizures and adjuvant for generalised tonic-clonic seizures

35
Q

What are 2 AEs of Topiramate?

A

1) Dizziness, fatigue
2) Ataxia
3) Confusion

36
Q

What is the moa of Duloxetine?

A

5-HT and NE reuptake inhibitor (SNRI) antidepressant

37
Q

What are 2 indications of Duloxetine?

A

1) Chronic/neuropathic pain
- low back/non-radicular neck pain
2) Clinical depression

38
Q

What are 3 AEs of Duloxetine?

A

Common:
1) Xerostomia
2) Abdo pain
3) Drowsiness
4) Fatigue
5) Headache
6) Weight loss

Severe:
7) Mania
8) Hypomania
9) Bleeding risk
10) Fragility fractures
11) Hepatoxicity
12) Hyponatremia
13) Ocular effects
14) Serotonin syndrome
15) Sexual dysfunction
16) Suicidal ideation

39
Q

What is the moa of amitriptyline?

A

TCA antidepressant inhibits reuptake of NE and serotonin (5-HT)

40
Q

What are 2 indications of amitriptyline?

A

1) Chronic/neuropathic pain
2) Clinical depression

41
Q

What are 3 AEs of amitriptyline?

A

Antihistamine:
1) Sedation
2) Weight gain

Anticholinergic:
3) Blurred vision
4) Xerostomia
5) Urinary retention
6) Constipation
7) Agitation
8) Tachycardia
9) Sweating

α1 blockade:
10) postural hypotension
11) tachycardia

42
Q

What are 3 analgesics used for myalgia?

A

1) Opioids (eg. tramadol)
2) Paracetamol
3) NSAIDs (eg. celecoxib)

43
Q

What are 3 muscle relaxants used for myalgia?

A

1) Orphenadrine
2) Benzodiazepines (eg. diazepam)
3) GABA derivatives (eg. baclofen, gabapentin)

44
Q

What are 3 adjuvants used for myalgia?

A

1) Anticonvulsants (eg. gabapentin, topiramate)
2) Antidepressants (eg. Duloxetine, amytriptiline)

Musculoskeletal System (15 decks)

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