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Imm/Musculoskel/Skin > Musculoskeletal Disorders (1) > Flashcards

Musculoskeletal Disorders (1) Flashcards

1
Q

P
Q
R
S
T

A

Palliation/provocation
Quality
Region/radiation
Severity
Timing of onset

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2
Q

Strain

A

Tearing of muscle or tendon

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3
Q

Sprain

A

Stretching or tearing of ligaments

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4
Q

Musculoskeletal conditions leading to Chronic Pains

A

Myalgia
Tendonitis
Bursitis

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5
Q

Musculoskeletal pain caused by injury

A

Strain
Sprain
Overexertion

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6
Q

What drugs can commonly cause myalgia?

A

statins?

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7
Q

What medications can commonly cause tendonitis?

A

aromatase inhibitors, fluoroquinolones, glucocorticoids, and statins.

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8
Q

What type of MSK injury can be caused by improper immunization technique?

A

rotator cuff tear or tendonitis.

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9
Q

Musculoskeletal Goals of therapy

A

Decreasing severity and duration of pain
Restore function of affected area
Prevent reinjury and disability
Prevent acute pain from becoming chronic persistent pain

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10
Q

Musculoskeletal exclusions for self-care

A

severe pain
duration of pain +10 days
week of OTC therapy continued pain
signs of systemic illness or condition
Visually deformed joint, limb weakness/numbness, or suspected fracture
pregnant
less than 2 years old

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11
Q

R Therapy
I
C
E

A

Rest
Ice
Compression
Elevation

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12
Q

Ice Therapy

A

Decrease swelling
constricts blood vessels
may have numbing effect to help with pain

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13
Q

Heat Therapy

A

Improves circulation
Relaxes muscles
Help with stiffness, spasms, cramping
Used for noninflammatory pain

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14
Q

Musculoskeletal Non-Drug Therapies

A

TENS
Acupressure
Spinal manipulation

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15
Q

TENS

A

Transcutaneous Electrical Nerve Stimulation

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16
Q

Musculoskeletal OTC Topical Therapies

A

Topical NSAIDs
Counterirritants
Topical Anesthetic
Other Topical Agents

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17
Q

Topical NSAIDs for Musculoskeletal

A

Diclofenac (Voltaren)

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18
Q

Counterirritants

A

Rubefacients
Cooling Agents
Vasodilators
Irritants w/o Rubefaction

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19
Q

Topical Anesthetic

A

Lidocaine

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20
Q

Other Topical Agents

A

Trolamine Salicylate (Aspercreme)

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21
Q

Systemic Analgesics

A

Non-NSAID Analgesic
NSAIDs
Skeletal Muscle Relaxants
Opioids

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22
Q

Clinical Considerations for Acetaminophen Use

A

non-inflammatory, non-severe pain
Liver toxicity
Duplication in therapy

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23
Q

Adult OTC Acetaminophen Dosing
325mg

A

Take 2 tablets every 4 to 6 hours as needed
10 tablets (3,250 mg)

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24
Q

Adult OTC Acetaminophen Dosing
500mg

A

Take 2 tablets q6h prn
6 tablets (3,000 mg)

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25
Q

Adult OTC Acetaminophen Dosing
650mg

A

Take 2 tablets every 8 hours
6 tablets (3,900 mg)

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26
Q

Clinical Considerations with NSAID Use
GI bleed:

A

History of GI bleeding or ulceration
Concurrently on glucocorticoid, SSRI, or anticoagulant therapy
Drink 3 or more alcoholic drinks per day
Age 60 or older

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27
Q

Clinical Considerations with NSAID Use
Cardiovascular risk:

A

Active CV disease or ischemic heart disease
Past cardiovascular event <6 months ago
Uncontrolled hypertension
Chronic heart failure

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28
Q

Clinical Considerations with NSAID Use
Renal insufficiency :

A

Renal insufficiency – avoid in patients:
CrCl <30mL/min

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29
Q

NSAIDs and Pregnancy

A

Not recommended in pregnant women 20 weeks gestation or later
rare but serious kidney dysfunction in fetus
Reduction in the production of amniotic fluid (oligohydramnios)
NSAIDs taken 30 weeks gestation or later…
Lead to premature closure of fetal ductus arteriosus (fetal artery connecting aorta and pulmonary artery)

Generally avoid NSAID use in 2nd and 3rd trimester of pregnancy unless benefits outweigh potential risks

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30
Q

Strategies to Provide Gastrointestinal Protection

A

PPI therapy - discontinue when nsaid discontinued
Misoprostol - avoid in women who are/may be pregnant
Select a COX-2 selective NSAID - consider added CV risk

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31
Q

Adult NSAID Dosing OTC
Aspirin
81mg tablets
325mg tablets

A

Avoid in high doses (>325mg)
Do not use for MSK pain
No max dose

32
Q

Adult NSAID Dosing OTC
Ibuprofen
200mg tablet or capsule

A

Take 1-2 tablets q4-6 hours as needed

33
Q

Adult NSAID Dosing OTC
Naproxen
220 mg tablet

A

Take 2 tablets once, then take 1 tablet every 8 to 12 hours as needed
660mg/day

34
Q

Tendon

A

Muscle to bone

35
Q

Ligament

A

Bone to bone

36
Q

Musculoskeletal Acute status

A

Less than 4 weeks

37
Q

Musculoskeletal subacute status

A

4 weeks to 3 months

38
Q

Musculoskeletal Chronic status

A

Greater than 3 months

39
Q

Musculoskeletal Mild pain

A

1-3

40
Q

Musculoskeletal Moderate pain

A

4-6

41
Q

Musculoskeletal Severe pain

A

7-10

42
Q

Overexertion

A

Sudden high-intensity exercise after long period of inactivity
Muscle damage caused by force generated in muscle fibers (improper exercise, tension, poor posture)

43
Q

First Degree Sprain (Grade I):

A

Minimal ligament damage
1 week
self-care

44
Q

Second Degree Sprain (Grade II):

A

Moderate tearing of ligament w/ marked swelling and bruising
2-6 weeks to heal
May require medical referral.

45
Q

Third Degree Sprain (Grade III):

A

Complete tearing of ligament popping sound
Medical referral/surgery
6-12 weeks

46
Q

Myalgia Description

A

Dull, diffuse, constant muscle ache; may also include weakness and muscle fatigue

47
Q

Tendonitis

A

Inflammation of tendon around joint
Loss of range and motion

48
Q

Bursitis

A

Inflammation of bursae within joints (knee, shoulder)

49
Q

Clinical Considerations for Diclofenac (Voltaren)

A

Off-label for general MSK pain
Apply up to 4 grams to affected area up to 4 times daily
Do not apply over broken or compromised skin
Do not use concurrently with oral NSAIDs

50
Q

Topical Counterirritants MOA

A

MOA: Create a paradoxical pain-relieving effect by producing a less severe pain to counter a more intense one
Stimulates nerves at site of pain superficially, distracting from the deep underlying pain in muscles and joints
May cause mild irritation, but can rarely cause serious burning of the skin

51
Q

arachidonic acid (AA) release and metabolism

A

AA in the membrane lipids
V phospholipase A2 + inflammatory stimuli
Free AA
V Enzymatically via the cyclooxygenase (COX1/2)
Unstable intermediate prostaglandin H2
V Different tissue-specific isomerases
Different biologically active prostanoids

52
Q

INHIBITION OF PROSTANOID SYNTHESIS

A

NSAIDs block prostaglandin and thromboxane formation by reversibly inhibiting COX activity. (not selective for COX-1 or COX-2)

53
Q

NSAIDs Properties

A

Combined anti-inflammatory, antipyretic, and analgesic properties
Inhibit the COX-mediated generation of prostanoids
Decrease levels of PGE2 in brain surrounding the hypothalamus
Hydrophobic molecules - Carboxylic acid group.
Categorized by class on one or more or key moieties in structure

54
Q

COX-1

A

expressed constitutively in most cells. (“housekeeping” functions)

55
Q

COX-2

A

readily inducible, its expression levels being dependent on the stimulus
Immediate early-response product markedly up-regulated by shear stress, growth factors, tumor promoters, and cytokines. (sites of inflammation and cancer)

56
Q

Kidney COX-2

A

Constitutively expressed in tissues
Regulates renal function and blood flow.

57
Q

NSAIDS adverse effects

A
  1. Central nervous system: Headaches, tinnitus, dizziness
  2. Cardiovascular: Fluid retention, HTN, edema, MI and congestive heart failure (CHF).
  3. Gastrointestinal: Abdominal pain, dyspepsia, NV and rarely, ulcers or bleeding.
  4. Hematologic: Thrombocytopenia, neutropenia, aplastic anemia.
  5. Hepatic: Abnormal liver function results and rare liver failure.
  6. Pulmonary: Asthma.
  7. Skin: Rashes, all types, pruritus.
  8. Renal: Renal insufficiency, renal failure, hyperkalemia, and proteinuria
58
Q

COX-2 selective inhibitors

A

coxibs
COX-2 inhibitors no impact on platelet aggregation,

59
Q

Aspirin

A

irreversibly inhibits platelet COX (COX-1) so that aspirin’s antiplatelet effect lasts 8–10 days (the life of the platelet).

Aspirin is now rarely used as an anti-inflammatory medication

Clinical uses is related to its antiplatelet effects.

60
Q

ACETAMINOPHEN MOA

A

Reduces central prostaglandin synthesis
Produces analgesia and antipyresis, little anti-inflammatory efficacy.

Weak COX-1 and COX-2 inhibitor in peripheral tissues, no significant anti-inflammatory effects

61
Q

Skeletal Muscle Relaxants (SMR) types of agents

A

Antispasticity agents
Antispasmodic agents

62
Q

Antispasticity agents:

A

Work at spinal cord and directly on skeletal muscles to improve hypertonicity and involuntary spasms

63
Q

Antispasmodic agents:

A

act at the brain stem to decrease muscle spasms through alterations of CNS conduction
Listed in Beers criteria due to increased risk of falls – avoid in elderly patients

64
Q

Clinical Considerations for SMR Therapy

A

Only used short term pharm therapy (2-3 weeks)
Long term use cause rebound symptoms and/or withdrawal symptoms

Agents cause dizziness/drowsiness
Assess tolerability before driving vehicle
Avoid alcohol while taking

Can use SMR therapy in combination w/ NSAIDs for added pain relief

65
Q

Baclofen
Lioresal

A

Boxed Warning: Avoid abrupt discontinuation due to risk of withdrawal symptoms

Requires renal dose adjustment for CrCl<80, avoid use in CrCl<30

66
Q

Tizanidine
Zanaflex

A

Capsule and tablet formulations are not interchangeable

67
Q

Carisoprodol
Soma

A

Schedule IV controlled substance

68
Q

Cyclobenzaprine
Flexeril

A

Causes anticholinergic side effects (dry mouth, urinary retention, dizziness)
Contraindicated in hyperthyroidism, arrhythmias, heart block

69
Q

Metaxalone
Skelaxin

A

No pearls

70
Q

Methocarbamol
Robaxin

A

no pearls

71
Q

Approach to Treating Acute Musculoskeletal Pain
(Non Lower Back)

A

Topical NSAID therapy with or without topical menthol
Oral NSAID therapy or acetaminophen
Acupressure or transcutaneous electrical nerve stimulation (TENS) therapy

72
Q

Approach to Treating Low Back Pain
Acute or Subacute Lower Back Pain

A

Nonpharmacological treatment is recommended for all patients (superficial heat)
Pharmacologic treatment if needed, NSAID or skeletal muscle relaxant therapy recommended

73
Q

Approach to treating Chronic Lower Back Pain

A

Nonpharmacological treatment for all

Inadequate response, consider:
NSAIDs
Tramadol
Duloxetine

Last line:
Opioids

74
Q

Prevention of Musculoskeletal Injury
Before Physical Activity

A

Warm up and stretching exercises before vigorous exercise
Wrap injured muscles/joints w/ protective bandage or tape
Appropriate, well-fitting footwear
Sufficient fluids
Do not push your physical limits

75
Q

Prevention of Musculoskeletal Injury
Lifestyle Modifications

A

Avoid sedentary lifestyle – Activity at least 5 day/wk
Use ergonomic controls to adjust posture, stresses, and motions
Use assistive devices to alleviate pressure on joints if needed (cane, walker)

Imm/Musculoskel/Skin (16 decks)

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