Musculoskeletal Disorders (1) Flashcards

Question

Adult OTC Acetaminophen Dosing 650mg

Answer 1

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

Answer 2

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

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

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

Answer 7

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

Answer 8

Take 1-2 tablets q4-6 hours as needed

Answer 9

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

Answer 10

Muscle to bone

Answer 11

Bone to bone

Answer 12

Less than 4 weeks

Answer 13

4 weeks to 3 months

Answer 14

Greater than 3 months

Answer 15

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

Answer 16

Minimal ligament damage 1 week self-care

Answer 17

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

Answer 18

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

Answer 19

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

Answer 20

Inflammation of tendon around joint Loss of range and motion

Answer 21

Inflammation of bursae within joints (knee, shoulder)

Answer 22

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

Answer 23

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

Answer 24

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

Answer 25

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

Answer 26

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

Answer 27

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

Answer 28

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)

Answer 29

Constitutively expressed in tissues Regulates renal function and blood flow.

Answer 30

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

Answer 31

coxibs COX-2 inhibitors no impact on platelet aggregation,

Answer 32

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.

Answer 33

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

Answer 34

Antispasticity agents Antispasmodic agents

Answer 35

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

Answer 36

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

Answer 37

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

Answer 38

Boxed Warning: Avoid abrupt discontinuation due to risk of withdrawal symptoms Requires renal dose adjustment for CrCl<80, avoid use in CrCl<30

Answer 39

Capsule and tablet formulations are not interchangeable

Answer 40

Schedule IV controlled substance

Answer 41

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

Answer 42

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

Answer 43

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

Answer 44

Nonpharmacological treatment for all Inadequate response, consider: NSAIDs Tramadol Duloxetine Last line: Opioids

Answer 45

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

Answer 46

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)