Musculoskeletal and Pain (Test 3) Flashcards
1
Q
What is pain?
A
Dynamic interaction between physical, cognitive, spiritual, emotional and environmental factors.
According to the American Pain Society (APS), pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
2
Q
What are the four phases of nociception?
A
- Transduction
- Transmission
- Perception
- Modulation
3
Q
What is transduction in the context of pain?
A
Begins when tissue is damaged; activates nociceptors A-delta fibers and C fibers.
4
Q
What happens during the transmission phase of nociception?
A
Conduction of pain impulses A-delta fibers and C fibers into the dorsal horn of the spinal cord then ascend to the brain.
5
Q
Define perception in pain.
A
Conscious awareness of pain influenced by culture, sex, previous experience with pain, life experiences, and expectations.
6
Q
What is modulation in the context of pain?
A
Substances that alter the pain experience, including neuromodulators like prostaglandins, bradykinin, histamine, endorphin, and endomorphins.
7
Q
What is the pain threshold?
A
Point at which a stimulus is perceived as pain.
8
Q
What is perceptual dominance?
A
Pain at one location may cause an increase in the threshold in another location.
9
Q
Define pain tolerance.
A
Duration of time or the intensity of pain that a person will endure before initiating pain responses.
10
Q
What characterizes acute pain?
A
Protective mechanism that something is wrong, lasting seconds to days with autonomic nervous system stimulation.
11
Q
What distinguishes somatic pain?
A
Superficial pain arising from skin, connective tissue, and bone, which is well localized.
12
Q
What is visceral pain?
A
Pain of internal organs, often not localized and may present as referred pain.
13
Q
What is referred pain?
A
Pain felt in an area removed or distant from its point of origin.
14
Q
Define chronic pain.
A
Persistent or intermittent pain lasting at least 3 to 6 months, often without physiological signs.
15
Q
What is neuropathic pain?
A
Result of trauma or disease of nerves, most often chronic.
16
Q
What are local anesthetics used for?
A
To provide pain relief in localized areas; an example is Lidocaine.
17
Q
Define opioid.
A
Natural or synthetic substance with properties similar to morphine.
18
Q
What is the difference between an opiate and a narcotic?
A
Opiate contains compounds found in opium; narcotic is a less specific term that may refer to any CNS-altering substance.
19
Q
What is the role of opiate agonists?
A
Used for severe acute pain, such as morphine.
20
Q
What are some common analgesics?
A
- Opiate agonists
- Opiate partial agonists
- Opiate antagonists
- Salicylates
- NSAIDs
21
Q
What are nonpharmacologic pain management strategies?
A
- General comfort measures
- Relaxation techniques
- Diversional activities
- Visualization
- Biofeedback
- Meditation
- TENS unit
22
Q
What are mu receptors responsible for?
A
Analgesia, respiratory depression, euphoria, sedation, and physical dependence.
23
Q
What are the common adverse effects of morphine?
A
- Respiratory depression
- Constipation
- Orthostatic hypotension
- Urinary retention
- Cough suppression
- Biliary colic
- Emesis
- Elevation of intracranial pressure
- Euphoria/dysphoria
- Sedation
- Miosis
- Neurotoxicity
24
Q
What is tolerance in relation to morphine?
A
Increased doses needed to obtain the same response, develops with analgesia, euphoria, sedation, and respiratory depression.
25
What is physical dependence?
Abstinence syndrome with abrupt discontinuation, including symptoms like yawning, rhinorrhea, and sweating.
26
What is the potency of fentanyl compared to morphine?
Fentanyl is 100 times more potent than morphine.
27
What are common formulations of fentanyl?
* Parenteral
* Transdermal patch
* Iontophoretic system
* Transmucosal delivery
28
What are the actions of opiate partial agonists?
Effective analgesic without prior administration of opiate agonists; subject to ceiling effect.
29
What is naloxone's role?
Pure opioid antagonist used to reverse the effects of opioids.
30
What is tramadol?
A nonopioid centrally acting analgesic with a risk of suicide.
31
What are the types of headaches?
* Migraine
* Cluster
* Tension type
* Chronic daily
32
What characterizes a migraine headache?
Lasts 4 to 72 hours, may have an aura, and includes unilateral head pain with nausea or vomiting.
33
What is a cluster headache?
Several attacks occurring during the day for days, followed by long periods of spontaneous remission.
34
What defines a tension-type headache?
Most common headache with mild-to-moderate bilateral pain and a sensation of tightness.
35
What is the duration of headaches described as long periods of spontaneous remission?
Days followed by a long period of spontaneous remission
## Footnote
This refers to the pattern of certain headache types, particularly migraines.
36
What triggers the activation of the trigeminal system?
Trigger factors
## Footnote
These factors can include various stimuli that provoke headache attacks.
37
What are the two forms of headaches mentioned?
Acute and chronic
## Footnote
These classifications help in understanding the duration and frequency of headaches.
38
What are the clinical manifestations of headaches?
Unilateral, intense, tearing, and burning pain
## Footnote
These symptoms are often associated with specific types of headaches, such as migraines.
39
What type of headache is most common?
Tension-Type Headache
## Footnote
This type of headache is prevalent among the general population.
40
Describe the sensation associated with Tension-Type Headache.
Mild-to-moderate bilateral headache with a sensation of a tight band or pressure around the head
## Footnote
This description helps distinguish Tension-Type Headaches from other headache forms.
41
What can trigger Tension-Type Headaches?
Stress, fatigue, acute illness, sensitivity to tyramine, MSG, ETOH
## Footnote
Identifying triggers can help in managing and preventing headaches.
42
What is Ergotamine used for?
To treat vascular headaches
## Footnote
Ergotamine is effective for certain types of headaches due to its vasoconstrictive properties.
43
What are some adverse effects of Ergotamine?
Dizziness, rhinitis, hypertension, abdominal pain, nausea/vomiting
## Footnote
These side effects are important to monitor in patients receiving this medication.
44
What medication is used for the treatment of migraine or cluster headaches?
Imitrex
## Footnote
Imitrex is a common choice for acute migraine management.
45
List some side effects of Imitrex.
* Dizziness
* Vertigo
* Tingling warm sensation
* Injection site reaction
## Footnote
These side effects should be discussed with patients before administration.
46
What are the three major groups of sedative-hypnotic drugs?
* Barbiturates
* Benzodiazepines
* Benzodiazepine-like drugs
## Footnote
Each group has distinct properties and clinical uses.
47
Name a common benzodiazepine.
Diazepam (Valium)
## Footnote
Diazepam is widely used for anxiety and other conditions.
48
What is a key characteristic of benzodiazepines in terms of safety compared to barbiturates?
Less addictive than barbiturates
## Footnote
This highlights the relative safety of benzodiazepines at therapeutic doses.
49
What is a significant risk when using benzodiazepines in patients with hepatic disease?
May take longer to excrete drug
## Footnote
This can lead to increased drug effects and potential toxicity.
50
What are some cardiovascular effects of benzodiazepines?
Minimal with oral dose, profound with IV medication (hypotension, cardiac arrest)
## Footnote
This difference emphasizes the importance of route of administration.
51
What is the antidote for benzodiazepine overdose?
Flumazenil (Romazicon)
## Footnote
Flumazenil can reverse the sedative effects, but its use must be carefully considered.
52
Fill in the blank: Benzodiazepines can cause ________ amnesia, which impairs memory after dose.
Anterograde
## Footnote
This side effect is significant, especially in clinical settings.
53
What is a fracture?
A fracture is a break in the continuity of a bone.
54
What are the classifications of fractures?
* Complete or incomplete
* Closed or open
* Comminuted
* Linear
* Oblique
* Spiral
* Transverse
* Greenstick
* Torus
* Bowing
* Pathologic
* Stress
* Fatigue and insufficiency
* Transchondral
55
What is tendinopathy?
Tendinopathy is an injury to a tendon.
56
What is a muscle strain?
A sudden, forced motion causing the muscle to become stretched beyond its normal capacity.
57
What serious condition can result from severe muscle trauma?
Rhabdomyolysis (myoglobinuria).
58
What are the potential complications of dislocation?
* Myositis Ossificans
* Rhabdomyolysis
* Crush syndrome
* Compartment syndromes
* Volkmann ischemic contracture
* Malignant hyperthermia
59
What causes osteoporosis?
* Decreased levels of estrogen and testosterone
* Decreased activity level
* Excess intake of caffeine, phosphorus, alcohol, nicotine
* Inadequate levels of vitamins D and C, or Mg
60
What characterizes osteoporosis?
Demonstrated by reduced bone mass/density and an imbalance of bone resorption and formation.
61
What is osteomalacia?
A deficiency of vitamin D that lowers calcium absorption from the intestines, leading to inadequate or delayed mineralization.
62
What are the manifestations of osteomalacia?
* Pain
* Bone fractures
* Vertebral collapse
* Bone malformation
63
What is osteomyelitis?
An infection of the bone most often caused by a staphylococcal infection.
64
What are the treatment options for osteomyelitis?
* Antibiotics
* Debridement
* Surgery
* Hyperbaric oxygen therapy
65
What differentiates inflammatory joint disease from noninflammatory joint disease?
* Absence of synovial membrane inflammation
* Lack of systemic signs and symptoms
* Normal synovial fluid analysis
66
What are the risk factors for osteoarthritis?
* Increased age
* Joint trauma
* Long-term mechanical stress
* Endocrine disorders (hyperparathyroidism)
* Drugs
* Obesity
67
What are the manifestations of osteoarthritis?
* Pain (worsens with activity)
* Stiffness (diminishes with activity)
* Enlargement of the joint
* Tenderness
* Limited motion
* Deformity
68
What are the initial manifestations of rheumatoid arthritis?
* Insidious onset
* General systemic manifestations of inflammation (fever, fatigue, weakness, anorexia, weight loss)
* Painful, tender, stiff, swollen joints
69
What is the criteria for evaluating rheumatoid arthritis?
* Morning joint stiffness lasting at least 1 hour
* Arthritis of three or more joint areas
* Arthritis of the hand joints
* Symmetric arthritis
* Rheumatoid nodules
* Abnormal amounts of serum rheumatoid factor
* Radiographic changes
70
What are the classes of antiarthritic drugs?
* NSAIDs
* DMARDs (Disease-modifying antirheumatic drugs)
* Nonbiologic DMARDs
* Biologic DMARDs
* Glucocorticoids
71
What is ankylosing spondylitis?
An inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusion of the joints.
72
What are the early symptoms of ankylosing spondylitis?
* Low back pain (begins in early 20s)
* Stiffness
* Pain
* Restricted motion
* Loss of normal lumbar curvature
* Increased concavity of upper spine
73
What are the clinical stages of gout?
* Asymptomatic hyperuricemia
* Acute gouty arthritis
* Tophaceous gout
74
What manifestations are associated with acute gouty attacks?
* Severe pain (especially at night)
* Hot, red, tender joint
* Signs of systemic inflammation (increased sedimentation rate, fever, leukocytosis)
75
What is fibromyalgia?
A condition characterized by diffuse, chronic pain and tenderness in specific points.
76
What are the clinical manifestations of osteogenesis imperfecta?
* Osteopenia
* Increased rate of fractures
* Bone deformity (bowing)
* Short stature
* Blue sclera and poor dentition
* Aortic aneurysm
77
What are the manifestations of Duchenne Muscular Dystrophy?
* Slow motor development
* Progressive weakness
* Muscle wasting
* Delayed sitting and standing
* Clumsiness and difficulty climbing stairs
78
What are the contraindications for Methotrexate?
Pregnancy (teratogenic), liver disease, alcoholism or chronic alcohol use, immunodeficiency syndromes, preexisting blood dyscrasias (bone marrow suppression).
79
What are the contraindications for Sulfasalazine?
Sulfa allergy, intestinal or urinary obstruction, porphyria, G6PD deficiency (risk of hemolysis), severe liver or kidney disease.
80
What are the contraindications for NSAIDs (nonselective: Ibuprofen, Naproxen)?
Peptic ulcer disease, GI bleeding history, renal impairment, cardiovascular disease (especially post-MI), concurrent anticoagulant use.
81
What are the contraindications for COX-2 Inhibitors (Celecoxib)?
Sulfonamide allergy, history of cardiovascular disease (stroke, MI), severe hepatic impairment, advanced renal disease.
82
What are the contraindications for Glucocorticoids (Prednisone, Prednisolone)?
Systemic fungal infections, live vaccines (if high-dose immunosuppression), caution in diabetes, hypertension, osteoporosis, psychosis.
83
What are the contraindications for TNF Inhibitors (Etanercept, Adalimumab, Infliximab)?
Active or latent TB (must be ruled out prior), active infections (fungal, viral, bacterial), demyelinating disorders (e.g., MS), heart failure (moderate to severe), history of malignancy.
84
What is a fracture?
A break in the continuity of a bone.
85
What are the types of fractures?
Complete, incomplete, closed, open, comminuted, linear, oblique, spiral, transverse, greenstick, torus, bowing, pathologic, stress, fatigue, insufficiency, transchondral.
86
What are signs and symptoms of an acute fracture?
Pain, swelling, deformity, decreased function, bruising, crepitus.
87
What is tendinopathy?
Disorder of the tendon due to overuse, including tendinitis and tendinosis.
88
What is bursitis?
Inflammation of the bursa, typically due to repetitive motion or pressure.
89
What is rhabdomyolysis?
Life-threatening complication of severe muscle trauma with muscle cell loss.
90
What are complications of rhabdomyolysis?
Crush syndrome, compartment syndrome, Volkmann ischemic contracture, malignant hyperthermia.
91
What causes osteoporosis?
Decreased estrogen/testosterone, low activity, excess caffeine/alcohol/nicotine, low vitamin D/C/Mg.
92
What is seen in osteoporosis?
Reduced bone mass/density with imbalance of bone resorption and formation.
93
What is osteomalacia?
Soft bones due to vitamin D deficiency and inadequate mineralization.
94
Symptoms of osteomalacia?
Pain, fractures, vertebral collapse, bone malformation.
95
What is Paget disease?
Disorder with thickened bones causing deformities and possible neurological effects.
96
Symptoms of Paget disease?
Bone curvatures, brain compression, motor issues, deafness, optic atrophy.
97
What is osteomyelitis?
Bone infection, commonly caused by staph, from wounds or bloodstream.
98
Symptoms of osteomyelitis?
Pain, fever, inflammation, necrotic bone.
99
Treatment of osteomyelitis?
Antibiotics, debridement, surgery, hyperbaric oxygen therapy.
100
Risk factors for osteoarthritis?
Age, joint trauma, stress, endocrine issues, drugs, obesity.
101
Symptoms of osteoarthritis?
Pain worsens with activity, stiffness improves with activity, joint deformity.
102
What is RA?
Systemic autoimmune disease causing joint inflammation and deformity.
103
RA diagnostic criteria?
Morning stiffness >1 hr, >=3 joints, hand joints, symmetric arthritis, nodules, RF+, x-ray changes.
104
What is ankylosing spondylitis?
Inflammatory disease causing spine and SI joint fusion.
105
Symptoms of ankylosing spondylitis?
Low back pain, stiffness, kyphosis, restricted motion.
106
What is gout?
Metabolic disorder with uric acid crystal deposition in joints.
107
Stages of gout?
Asymptomatic hyperuricemia, acute gouty arthritis, tophaceous gout.
108
Acute gout symptoms?
Severe joint pain, redness, swelling, systemic inflammation.
109
What is fibromyalgia?
Chronic condition with widespread pain and multiple tender points.
110
Symptoms of fibromyalgia?
Diffuse pain >3 months, fatigue, tenderness in >=11 points.
111
What is osteogenesis imperfecta?
Genetic disorder causing brittle bones.
112
Symptoms of OI?
Fractures, bowing, short stature, blue sclera, poor dentition.
113
Treatment for OI?
Calcium, vitamin D, bisphosphonates, surgical rods.
114
What is Duchenne MD?
X-linked disorder causing progressive muscle degeneration.
115
Symptoms of Duchenne MD?
Delayed motor development, muscle weakness, frequent falls.
116
What type of pain is a patient experiencing 2 hours post-abdominal surgery with sharp localized pain (7/10)?
Acute somatic pain
117
What is the management for acute post-op pain?
Opioid agonists (e.g., morphine), monitor for respiratory depression
118
What type of pain does a 58-year-old with diabetes experience with burning, tingling foot pain for 6 months?
Chronic peripheral neuropathic pain
119
What is the management for chronic diabetic neuropathy?
Gabapentin, duloxetine; avoid opioids long-term
120
What is the likely diagnosis for a 30-year-old with pulsating unilateral headache, nausea, and photophobia?
Migraine
121
What is the management for a sudden migraine attack?
Sumatriptan; caution with SSRIs/SNRIs due to serotonin syndrome
122
What type of pain does a woman experience weeks after mastectomy with phantom limb pain?
Central neuropathic pain
123
What is the management for pain after mastectomy?
Antidepressants, antiepileptics, non-opioid adjuvants
124
What is the drug of choice for a woman in labor who requests pain relief but wants to remain alert?
Opiate partial agonist (e.g., nalbuphine or butorphanol)
125
Why is an opiate partial agonist preferred during labor?
Less respiratory depression; maintains alertness
126
What are the symptoms of a suspected opioid overdose?
Pinpoint pupils, respiratory depression, and unconsciousness
127
What is the likely cause of pinpoint pupils and respiratory depression in a patient?
Opioid overdose (e.g., morphine, fentanyl)
128
What is the management for opioid overdose?
Administer naloxone (Narcan) immediately
129
What is the management for a post-op cancer patient with a history of opioid addiction?
Use non-opioid analgesics first, consider tramadol or partial agonists
## Footnote
Monitor closely; involve pain management team.
130
What type of fracture do you suspect in a 72-year-old woman with intense hip pain, unable to bear weight, and an externally rotated and shortened leg?
Suspect a hip fracture. Priorities: immobilize the limb, manage pain, monitor for shock, and prepare for imaging/surgery.
131
In a 45-year-old tennis player with shoulder pain worse with movement and improving with rest, which condition is more likely: tendinopathy or bursitis?
Tendinopathy is more likely. Treatment: Tendinopathy - rest, NSAIDs, physical therapy; Bursitis - aspiration or corticosteroid injection may be needed.
132
What condition do you suspect in a construction worker with dark red-brown urine and muscle pain after being trapped under debris?
Suspect rhabdomyolysis. Check serum creatine kinase (CK). First action: initiate aggressive IV hydration to prevent kidney damage.
133
Identify the modifiable risk factors for osteoporosis in a postmenopausal woman with a sedentary lifestyle who drinks 4 cups of coffee daily and smokes.
Modifiable risks: caffeine, smoking, inactivity. Teach: weight-bearing exercise, vitamin D/calcium, stop smoking, reduce caffeine.
134
What condition is likely in a patient from a region with limited sunlight presenting with bone pain, waddling gait, and frequent fractures?
Likely osteomalacia. Unlike osteoporosis (reduced density), osteomalacia involves defective bone mineralization causing soft bones.
135
What condition do you suspect in a man in his 60s with hearing loss, frequent headaches, and a bowed leg, with X-rays showing thickened but structurally weak bones?
Paget disease. Monitor for neurologic complications (hearing loss, nerve compression) and heart failure due to high-output circulation.
136
What condition might be developing in a diabetic patient with an open wound on the foot that isn't healing, fever, and increased pain around the wound site?
Suspect osteomyelitis. Diagnosis: bone biopsy or MRI. Treatment: IV antibiotics, debridement, possibly surgery.
137
What condition does a 65-year-old woman with knee pain that worsens with activity and improves with rest, along with enlarged and stiff joints in the morning, describe?
Osteoarthritis. OA is localized, affects weight-bearing joints, and has short-lived morning stiffness. RA is systemic and inflammatory.
138
What autoimmune condition is likely in a 40-year-old woman with morning joint stiffness >1 hour, fatigue, and symmetrical swelling in both wrists and hands?
Rheumatoid arthritis. Labs: RF, anti-CCP, ESR, CRP. Criteria: >=4 features including joint involvement, symmetry, stiffness.
139
What condition does a 25-year-old male with chronic low back pain and stiffness that improves with exercise suggest?
Ankylosing spondylitis. Posture changes: loss of lumbar curve, kyphosis of thoracic spine.
140
What is the likely diagnosis for a man complaining of sudden, severe pain in his big toe at night, which is red, swollen, and tender?
Gout. Avoid high-purine foods (red meat, shellfish), alcohol (especially beer), and sugary drinks. Encourage hydration.
141
What is the most likely diagnosis for a 35-year-old woman reporting widespread burning muscle pain for over 3 months, fatigue, and poor sleep?
Fibromyalgia. Recommend exercise, stress management, cognitive behavioral therapy, and sleep hygiene.
142
What condition do you suspect in a toddler with frequent fractures, blue sclera, and short stature, with family history revealing similar symptoms?
Osteogenesis imperfecta. Handle gently to prevent fractures. Focus on safe mobility and bone health management.
143
What disorder is likely in a 4-year-old boy with trouble climbing stairs, frequent falls, and large calf muscles?
Duchenne muscular dystrophy. Progressive muscle weakness, eventual loss of ambulation, respiratory and cardiac complications.
144
What is Fracture?
A break in the continuity of a bone.
145
What is Comminuted Fracture?
Bone is broken into more than two fragments.
146
What is Greenstick Fracture?
An incomplete fracture where the bone bends; common in children.
147
What is Tendinopathy?
Disease of a tendon due to overuse; includes tendinitis and tendinosis.
148
What is Bursitis?
Inflammation of the bursa, often caused by repetitive movement.
149
What is Rhabdomyolysis?
Breakdown of muscle tissue releasing myoglobin into the bloodstream, potentially damaging the kidneys.
150
What is Crush Syndrome?
Systemic complication of severe trauma or muscle injury leading to rhabdomyolysis.
151
What is Compartment Syndrome?
Increased pressure within a muscle compartment leading to compromised circulation.
152
What is Osteoporosis?
A condition in which bone density is reduced, increasing fracture risk.
153
What is Osteomalacia?
Softening of bones due to defective bone mineralization, often from vitamin D deficiency.
154
What is Paget Disease?
A bone disorder causing abnormal bone remodeling and thickening.
155
What is Osteomyelitis?
Infection of the bone, often caused by bacteria like Staphylococcus aureus.
156
What is Osteoarthritis?
Degenerative joint disease involving the breakdown of cartilage.
157
What is Rheumatoid Arthritis?
Autoimmune inflammatory disorder affecting joints symmetrically.
158
What is DMARDs?
Disease-modifying antirheumatic drugs used to treat RA by slowing disease progression.
159
What is NSAIDs?
Nonsteroidal anti-inflammatory drugs used to reduce inflammation and pain.
160
What is Glucocorticoids?
Steroid hormones used to suppress inflammation.
161
What is Ankylosing Spondylitis?
Chronic inflammatory disease causing fusion of the spine and sacroiliac joints.
162
What is Gout?
Metabolic disorder with uric acid crystal deposits in joints causing acute inflammation.
163
What is Tophi?
Deposits of urate crystals in tissues, characteristic of chronic gout.
164
What is Fibromyalgia?
Chronic condition characterized by widespread pain, fatigue, and tender points.
165
What is Osteogenesis Imperfecta?
Genetic disorder leading to brittle bones and frequent fractures.
166
What is Duchenne Muscular Dystrophy?
X-linked disorder causing progressive muscle degeneration, typically in boys.
167
Morphine: Contraindications
Respiratory depression, severe asthma or COPD, paralytic ileus, head injury or increased intracranial pressure, hypersensitivity to opioids.
168
Fentanyl: Contraindications
Severe respiratory disease, known intolerance or hypersensitivity, use with MAO inhibitors within 14 days.
## Footnote
Caution: elderly, opioid-naive, or heat exposure (patch).
169
Methadone: Contraindications
Severe liver disease, severe asthma or breathing problems, history of prolonged QT interval, concomitant use with other QT-prolonging drugs.
170
Oxycodone/Hydrocodone: Contraindications
Respiratory depression, acute/severe asthma, paralytic ileus, hypersensitivity to any component, significant CNS depression.
171
Tramadol: Contraindications
Seizure disorders, concurrent MAOI or SSRI use (risk of serotonin syndrome), severe asthma or respiratory depression, children under 12, post-tonsillectomy or adenoidectomy.
172
Naloxone: Contraindications
None absolute - use cautiously in opioid-dependent patients.
## Footnote
Can precipitate acute withdrawal syndrome.
173
Ergotamine: Contraindications
Pregnancy (Category X), coronary artery disease or peripheral vascular disease, severe hypertension, liver or renal impairment, concurrent use with potent CYP3A4 inhibitors.
174
Sumatriptan: Contraindications
Ischemic heart disease, angina, MI history, uncontrolled hypertension, hemiplegic or basilar migraine, use within 24 hours of ergotamines or other triptans.
175
Benzodiazepines: Contraindications
Severe respiratory insufficiency, sleep apnea syndrome (untreated), severe hepatic impairment (esp. diazepam), narrow-angle glaucoma, pregnancy (Category D/X for some).
176
What is acute pain?
A protective mechanism indicating something is wrong, lasting seconds to days.
## Footnote
ANS stimulation includes increased HR, BP, diaphoresis, and dilated pupils.
177
What are the types of acute pain?
Somatic (localized) and Visceral (deep, referred).
178
What is chronic pain?
Pain that lasts at least 3 to 6 months and can be persistent or intermittent.
## Footnote
Response patterns vary and may lead to psychological and behavioral changes.
179
What is neuropathic pain?
Pain due to trauma or disease of nerves, most often chronic.
## Footnote
Types include Peripheral (e.g. diabetic neuropathy) and Central (e.g. phantom limb).
180
What are the characteristics of a migraine headache?
Lasts 4 to 72 hours with unilateral pain, pulsating, nausea/vomiting, and photophobia.
## Footnote
Triggers include stress, certain foods, and hormonal changes; can occur with or without aura.
181
What is a cluster headache?
Unilateral, intense, tearing pain often around the eye, occurring in clusters followed by remission periods.
## Footnote
Involves trigeminal system activation.
182
What is a tension-type headache?
The most common type of headache characterized by bilateral mild-to-moderate pain, feeling like a tight band or pressure around the head.
## Footnote
Can be acute or chronic.
183
What is referred pain?
Pain felt in an area distant from the origin, often caused by visceral pain being perceived elsewhere.
## Footnote
Common with internal organ issues.
184
Morphine: Adverse Effects
Respiratory depression, constipation, orthostatic hypotension, urinary retention, cough suppression, biliary colic, nausea/vomiting, increased ICP, euphoria/dysphoria, sedation, miosis, neurotoxicity, hormonal changes, tolerance and physical dependence, drug interactions.
185
Fentanyl: Key Info
100x potency of morphine. Routes: Parenteral, Transdermal, Transmucosal. Transdermal caution: Avoid heat sources. Used for surgical anesthesia and chronic pain.
186
Methadone: Uses and Risks
Used in pain management and opioid dependence. Long and variable half-life-risk of accumulation. Can prolong QT interval-monitor ECG.
187
Oxycodone and Hydrocodone
Moderate to severe pain. Oxycodone: Immediate and controlled-release forms. Hydrocodone: Often combined with acetaminophen. High abuse potential.
188
Partial Opioid Agonists
Drugs: Buprenorphine, Butorphanol, Nalbuphine, Pentazocine. Ceiling effect-less risk of respiratory depression. Uses: Short-term pain relief, surgical/obstetric pain. AE: Sedation, nausea, hallucinations, respiratory depression.
189
Opioid Antagonists: Naloxone (Narcan)
Reverses opioid overdose. Blocks effects at opioid receptors. Short half-life-may need repeat doses. Can cause withdrawal symptoms in dependent individuals.
190
Tramadol: Centrally Acting Analgesic
Dual mechanism: weak opioid + serotonin/norepinephrine reuptake inhibition. Risk of serotonin syndrome. AE: Dizziness, nausea, seizure risk, suicide risk.
191
Clonidine: Pain Use
Alpha2 agonist, blocks nerve signals to brain. Epidural for cancer pain. AE: Hypotension, bradycardia.
192
Ergotamine (Headaches)
Used in vascular headaches, causes vasoconstriction. AE: Dizziness, rhinitis, HTN, abdominal pain, N/V. Interactions: CYP3A4 inhibitors.
193
Sumatriptan (Imitrex)
Used for migraines and cluster headaches. AE: Dizziness, tingling, warm sensations. Caution with SSRIs/SNRIs: Risk of serotonin syndrome.
194
Benzodiazepines
Examples: Diazepam, Lorazepam, Alprazolam. Uses: Anxiety, insomnia, sedation. AE: Respiratory depression (IV), amnesia, dependence. ANTIDOTE: Flumazenil (Romazicon).
195
What is nociception?
The perception of pain through a 4-phase process: 1. Transduction: tissue damage activates nociceptors 2. Transmission: pain signals travel to CNS 3. Perception: conscious awareness of pain 4. Modulation: substances modify the pain experience
196
What is pain threshold?
The point at which a stimulus is perceived as pain. Generally similar among individuals.
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What is pain tolerance?
The duration or intensity of pain a person can endure. Varies widely based on culture, experiences, and mood.
198
What are opioid receptors?
Mu: analgesia, respiratory depression, euphoria, sedation; Kappa: analgesia, sedation, psychotomimetic effects; Delta: less understood; potential role in pain modulation.
199
What are analgesics?
Drugs that relieve pain without causing loss of consciousness. Classes: Opioid agonists, partial agonists, antagonists, NSAIDs, salicylates, misc.
200
What is neuropathic pain?
Pain due to nerve injury or dysfunction. Often chronic and burning, tingling, or shooting in quality.
## Footnote
Examples: diabetic neuropathy, phantom limb pain.
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What is referred pain?
Pain felt at a location distant from its source. Occurs due to shared spinal nerves or misinterpretation by the brain.
202
What is a partial agonist opioid?
Stimulates some opioid receptors but blocks others. Less risk of respiratory depression.
## Footnote
Examples: Buprenorphine, Butorphanol, Nalbuphine.
203
What is the mechanism of action of NSAIDs in treating RA?
Inhibit cyclooxygenase (COX), reducing prostaglandin synthesis, inflammation, and pain.
204
What are the two types of NSAIDs?
First-generation (inhibit COX-1 and COX-2) and second-generation (selectively inhibit COX-2, e.g., celecoxib).
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What are major risks of NSAIDs?
Thrombotic events, gastrointestinal ulceration, and bleeding.
206
When are oral glucocorticoids used in RA?
For generalized symptoms of RA.
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When are intra-articular glucocorticoids used?
When one or two joints are affected.
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What are common glucocorticoids used in RA?
Prednisone and prednisolone.
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What are side effects of glucocorticoids?
Hyperglycemia, osteoporosis, infection risk, mood changes, adrenal suppression.
210
What is the most rapid-acting DMARD?
Methotrexate.
211
How long does methotrexate take to work?
3 to 6 weeks.
212
What are adverse effects of methotrexate?
Hepatic fibrosis, bone marrow suppression, gastrointestinal ulceration, pneumonitis.
213
Name another nonbiologic DMARD.
Sulfasalazine.
214
What do TNF inhibitors do?
Suppress immune function by neutralizing tumor necrosis factor (TNF).
215
Name TNF inhibitor biologics used in RA.
Etanercept (Enbrel), Adalimumab (Humira), Infliximab (Remicade), Certolizumab (Cimzia), Golimumab (Simponi).
216
What are side effects of TNF inhibitors?
Serious infections, allergic reactions, heart failure, hematologic and liver disorders, CNS demyelinating disorders.
217
What are common monoclonal antibodies used in RA?
Infliximab, Adalimumab, Golimumab, Certolizumab.
218
What are important side effects of *mab drugs*?
Infusion reactions, immunosuppression, increased cancer risk, liver toxicity, reactivation of TB or hepatitis B.
219
What foods should be avoided with gout?
High purine foods (e.g., red meat, shellfish), alcohol, and sugary drinks.
220
What are the types of fractures?
Comminuted, Linear, Oblique, Spiral, Transverse, Greenstick, etc.
221
What is a key stage in bone healing?
Callus formation.
222
What is compartment syndrome?
Increased pressure in a closed space -> impaired circulation & tissue damage.
223
What is rhabdomyolysis?
Muscle breakdown -> release of myoglobin -> kidney damage risk.
224
What is osteoporosis?
Reduced bone mass/density; risk factors include low estrogen/testosterone, inactivity, poor nutrition.
225
What causes osteomalacia?
Vitamin D deficiency -> soft bones; calcification does not occur.
226
What characterizes Paget disease?
Abnormal bone remodeling; thickened, disorganized bones.
227
What is osteomyelitis?
Infection of the bone, commonly due to Staphylococcus.
228
How do osteoarthritis and rheumatoid arthritis differ?
OA is localized wear & tear, RA is systemic and autoimmune.
229
What are the drugs for rheumatoid arthritis?
NSAIDs, Glucocorticoids, Nonbiologic & Biologic DMARDs (e.g., Methotrexate, Etanercept).
230
What are the phases of nociception?
Transduction, Transmission, Perception, Modulation.
231
What are the types of pain?
Acute, Chronic, Neuropathic (peripheral/central), Referred.
232
What are the types of headaches?
Migraine (± aura), Cluster (unilateral), Tension-type (bilateral).
233
What are the methods of pain management?
Pharmacologic (opioids, NSAIDs, etc.) and nonpharmacologic (TENS, meditation, etc.).
234
What are the types of opioid receptors?
Mu (euphoria, respiratory depression), Kappa (analgesia, psychotomimetic), Delta.
235
What are the risks associated with morphine?
High risk of respiratory depression, constipation, hypotension, dependence.
236
What is notable about fentanyl?
100x morphine potency, caution with transdermal use (heat, opioid-naive patients).
237
What is a risk associated with methadone?
Long half-life, risk of QT prolongation.
238
What is sumatriptan used for?
For migraines; contraindicated in cardiac conditions and with other triptans.
239
What does naloxone do?
Reverses opioid overdose, short half-life - repeat dosing may be needed.
