Musculoskeletal Considerations Flashcards
What are the main topics covered in the musculoskeletal considerations lecture?
Medications, corticosteroids, anabolic steroids, psychotropic meds, rheumatological meds, muscle relaxants, neuropathic medications, post-op joint replacement and fracture management, patient case examples, education on medications.
What are the considerations for chronic pain management?
Long-term use of medications, managing side effects, appropriate medication combinations, and monitoring for adverse events.
What are common pain medications used post-operatively?
- opioids
- acetaminophen
- anticoagulants
- muscle relaxants
- antibiotics
- stool softeners
What are the main goals of drug therapy for rheumatoid arthritis (RA)?
- decrease joint inflammation
- stop disease progression
What are the three main categories of drugs used for RA?
NSAIDs, glucocorticoids, disease-modifying antirheumatic drugs (DMARDs).
How do NSAIDs work in RA management?
Inhibit the COX enzyme, added pain relief, inhibition of prostaglandin synthesis.
What are the adverse effects of chronic NSAID use?
Stomach irritation, gastric ulceration, hemorrhage.
What is the controversy around intra-articular glucocorticoids for RA?
They may produce harmful catabolic effects in joints weakened by arthritic changes.
How do glucocorticoids reduce joint inflammation?
- Inhibiting the production of pro-inflammatory substances
- Increasing anti-inflammatory proteins
What are the adverse effects of glucocorticoids?
Muscle wasting, osteoporosis, hypertension, aggravation of diabetes, glaucoma, cataracts, increased infection risk.
What is the primary focus of DMARDs in RA treatment?
Delay disease progression, promote remission, control synovitis and erosive changes.
What are some common DMARDs used for RA?
- Antimalarials (Chloroquine, Hydroxychloroquine)
- Gold compounds (Auranofin)
- Non-biological (Methotrexate)
- Biological (Adalimumab, Infliximab)
What is Methotrexate commonly used for?
RA and cancer, slows RA effects, decreases synovitis and bone erosion, reduces joint space narrowing.
What are the adverse effects of Methotrexate?
GI issues, nausea, headache, long-term users may experience pulmonary problems, liver dysfunction, and hair loss.
How can diet affect RA symptoms?
Diets high in fatty acids and antioxidants can control inflammation, while meat and protein may exacerbate RA.
What is osteoarthritis (OA)?
A common joint disease caused by intrinsic defects in joint cartilage and subchondral bone remodeling.
How is OA commonly managed?
Pain management, maintaining an active lifestyle, using acetaminophen and NSAIDs, and topical treatments.
What are disease-modifying osteoarthritis drugs (DMOADs)?
Viscosupplementation with hyaluronan, glucosamine, and chondroitin sulfate supplements.
What are the rehab considerations for patients with RA and OA?
Medications should facilitate exercise and functional activity, be aware of adverse effects, and use ROM and strengthening exercises to avoid further injuries.
What are skeletal muscle relaxants used for?
Treat spasticity and muscle spasms, decrease muscle excitability and contraction.
What is the difference between spasticity and spasms?
- Spasticity is related to spinal cord or brain injuries
- Spasms are involuntary muscle contractions often after MSK injuries
What are anti-spasm drugs?
Diazepam, centrally acting drugs like Metaxalone, Cyclobenzaprine, and Methocarbamol.
What are the adverse effects of anti-spasm drugs?
Sedation, dizziness, nausea, light-headedness, ataxia, and headache.
What is Baclofen used for?
Reducing muscle spasticity, especially in conditions like MS, with fewer generalized weakness effects.
What are the adverse effects of Baclofen?
Drowsiness, confusion, hallucinations, more common in older adults or post-CVA patients.
What is Intrathecal Baclofen used for?
Used for reducing muscle spasticity, delivered directly into the subarachnoid space in the spinal cord.
What are the adverse effects of Intrathecal Baclofen?
Pump malfunctions, delivery catheter problems, withdrawal symptoms, tolerance due to long-term use.
What is Dantrolene Sodium used for?
Used for severe spasticity, inhibits calcium channel opening in skeletal muscle.
What are the adverse effects of Dantrolene Sodium?
Generalized muscle weakness, drowsiness, dizziness, nausea, diarrhea.
What is Gabapentin used for?
Originally an antiseizure drug, used for neuropathic pain, inhibits calcium into nerve terminals.
Now can be used as an antispasticity drug
What are the adverse effects of Gabapentin?
Sedation, fatigue, dizziness, ataxia.
What is Tizanidine used for?
Used for controlling spasticity from spinal lesions, chronic headaches, fibromyalgia.
What are the adverse effects of Tizanidine?
Sedation, dizziness, dry mouth, less generalized weakness than Baclofen or Diazepam.
How are muscle relaxants absorbed and metabolized?
Absorbed easily in the GI tract, metabolized by hepatic enzymes, excreted through kidneys.
What are the rehab considerations for muscle relaxants?
Compliment PT treatments, reduce spasticity to improve participation, avoid long-term use, monitor for sedation and muscle weakness.
What are the common types of anesthesia?
General (inhaled, IV), local (injection, topical), regional (spinal anesthesia).
What are the stages of anesthesia?
- Stage I: Analgesia
- Stage II: Excitement (Delirium)
- Stage III: Surgical Anesthesia
- Stage IV: Medullary Paralysis.
What are the side effects of general anesthesia?
Confusion, delirium, muscle weakness, bronchial secretions, long-term cognitive effects.
How do local anesthetics work?
Block nerve conduction by inhibiting sodium channels in the nerve membrane.
What are common local anesthetics?
Lidocaine, Procaine, Bupivacaine.
What are the adverse effects of local anesthetics?
Allergic reactions, CNS toxicity, cardiovascular effects.
How do psychotropic medications affect MSK conditions?
Affect neurotransmitter levels, which can influence pain perception and mood, impacting MSK conditions.
What are the common psychotropic medications used in MSK conditions?
Antidepressants, antipsychotics, mood stabilizers, anxiolytics.
What are the adverse effects of psychotropic medications?
Sedation, dizziness, weight gain, dry mouth, constipation, blurred vision.
How do gut-liver complications affect medication metabolism?
Medications metabolized by the liver can be affected by gut-liver complications, altering their effectiveness and safety.
What are common gut-liver complications related to medications?
Cirrhosis, hepatitis, fatty liver disease, drug-induced liver injury.
What are the rehab considerations for patients with gut-liver complications?
Adjust medication dosages, monitor liver function, be aware of potential interactions.
How do neuropathic medications work?
Inhibit nerve signal transmission involved in pain perception, often through calcium or sodium channels.
What are common neuropathic medications?
Gabapentin, Pregabalin, Amitriptyline.
What are the adverse effects of neuropathic medications?
Sedation, dizziness, fatigue, ataxia, nausea.
