Non-narcotic pain management Flashcards
Where do corticosteroids inhibit on the pain pathway?
inhibits release of arachidonic acid from the cell mb by inhibiting phospholipase
where do NSAIDs and aspirin inhibit on the pain pathway?
inhibits formation of prostaglandins by inhibiting COX
what are potential complications of NSAIDs?
- can exacerbate asthma symptoms
- ulcers; perforation, dyspepsia
- HTN, MI, stroke, CHF
- impaired renal fxn
what are GI risk factors with NSAID use?
- concomitant use w/ other NSAIDs, aspirin, corticosteroids, anticoagulants
- age > 65
- use of high dose NSAIDs
- CV disease
what are the CV risks with COX-2 inhibitors?
vasoconstriction
platelet aggregation
thrombosis
what are renal effects of NSAIDs?
COX 1 maintains GFR
COX 2 found in kidneys
what MSK effects do NSAIDs have?
- decrease adhesions of tendons
- decrease osteophyte formation
- decreased bone healing and increased non union rates
NSAIDs may decrease effect of which drugs?
beta-blockers
ACEI
diuretics
NSAIDs may increase levels of what drugs?
lithium
methotrexate
what AE does use of NSAID with cyclosporine cause?
nephrotoxicity
NSAID has synergistic effect with what drug?
warfarin- cause increased bleeding
describe metabolism of NSAIDs.
metabolized in liver
excreted in kidneys
which drug should you not give to children due to potential cause of Reye’s syndrome?
aspirin
which drug can antagonize gout meds?
aspirin
what is the max. dosage of aspirin?
3g per day
which drug should be taken with food?
ibuprofen
what is max dose of Ibuprofen?
3200mg
which NSAID is more CV neutral than others?
naproxen
*but can affect BP
which drug is quite potent and treatment should not exceed 5 days?
ketorolac
which drug is more COX-2 selective and thought to have less GI side effects?
Meloxicam
which NSAID are you supposed to check for elevated liver enzymes?
diclofenac
which drug is available in many forms- patch, gel, injection?
diclofenac
which NSAID is our only true COX-2 selective inhibitor?
celecoxib
name the injectable NSAIDs
diclofenac
ketorolac
which drug must be used with caution due to sulfa allergy?
celecoxib
side effects of corticosteroids?
- weight gain
- steroid induced DM
- increased blood glucose
- osteoporosis
- immunosuppression
- tendon rupture
- adrenal insufficiency
due to adrenal insufficiency with long term use of steroids, be sure to taper patients off corticosteroids slowly.
true
which corticosteroid is administered as a dose pack?
methyprednisilone
for most podiatric sx, what are the guidelines for corticosteroid supplementation?
- if on 5mg or less, no supplmentation needed
- give patient regular dose
- 25mg prior to start of procedure on top of regular dose
what are steroid injection indications for intra-articular diseases?
- osteoarthritis
- traumatic arthritis
- capsulitis
- sinus tarsitis
what are injection indications for non-articular diseases?
- tendonitis (but do not inject around achilles)
- plantar fasciitis
- neuromas or nerve entrapments
- ganglion cysts
what are absolute contraindications for steroid injections?
- joint sepsis
- prosthesis
- fracture
- bacteremia
what are relative contraindications for steroid injections?
-joint instability
-coagulopathy
-cellulitis
-poor response to injections at that site
>3-4 injections at a particular joint or soft tissue area in past year
what is the appearance of phosphate steroid injections?
water-soluble
clear
short-acting
what is teh appearnce of acetates steroid injections?
water-insoluble
cloudy
longer acting
can crystallize (so should not use in joint injections)
what are teh 3 most common steroid injections used in podiatry?
- dexamethasone
- triamcinolone
- betamethasone
what is max. dose of acetaminophen?
4g
what drug does not have anti-inflammatory properties?
acetaminophen
name some adjuvant drugs.
acetaminophen
muscle relaxants
which drugs can be used to treat neuropathic pain?
amitriptyline
gabapentin
pregabalin
duloxetine
what is most common side effect of gabapentin?
drowsiness
which drug can cause serotonin syndrome?
tapentadol
what drug is used for post-herpetic neuralgia?
lidoderm
what is MOA of capsaicin?
depletes and inhibits substance P accumulation
what is ionophoresis?
noninvasive way to deliver meds of like charge thru skin using direct current
what is phonophoresis?
noninvasive way of delivering meds using ultrasound
what is TENS?
device that delivers mild, electrical current thru skin
*blocks pain thru endorphin release by blocking pain fibers
Which drugs should you taper off when stopping meds?
corticosteroids Duloxetine amitryptiline gabapentin pregabalin
