non opiates 2

Question 1

what neurotransmitters are involved in the neuropathic pain pathway?

Answer 1

serotonin (inhibits and promotes pain perception) and norepinephrine (primarily inhibitory)

Question 2

SNRIs

Answer 2

serotonin-norepinephrine reuptake inhibitors

Question 3

antidepressant drugs that are used as analgesics

Answer 3

doxepin, milnacipran (fibromyalgia), amitrityline, duloxetine

Question 4

antiseizure drugs used as analgesics

Answer 4

phenytoin, carbamazepine, pregabalin

Question 5

which is better for pain: antiseizure drugs, antidepressants

Answer 5

antidepressants - antiseizure drugs focus on Na channels

Question 6

what did carbamazepine begin treating?

Answer 6

trigeminal neuralgia (better for pain)

Question 7

do SSRIs help relieve pain?

Answer 7

not as well as SNRIs

Question 8

how do antiseizure drugs decrease pain experienced?

Answer 8

decrease excitatory transmission, inactivate Na channels (not a class effect)

Question 9

which antiseizure/antidepressant drugs are albeled for use to decrease pain?

Answer 9

minacipran, gabapentin, duloxetine, carbamazepine, pregabalin

Question 10

MOA of pregabalin

Answer 10

effect on presynaptic N-type channels, sits in GAMA receptor sites (doesn’t mimic it)

Question 11

ADRs of pregabalin

Answer 11

dizziness, sleepiness, peripheral edema, weight gain, suicide risk warning (screen for this!), slow taper when d/c

Question 12

max dose of pregabalin?

Answer 12

450mg/day

Question 13

Duloxetine MOA

Answer 13

serotonin and NE reuptake

Question 14

ADR of duloxetine

Answer 14

CNS sxs like sleepiness, fatigue, eadache, nausea, xerostomia, suicide risk warning

Question 15

Goals of treating osteoarthritis

Answer 15

control pain/swelling, minimize disability, improve QOL, educate on disease mgmt (lifestyle)

Question 16

what is osteoarthritis AKA?

Answer 16

degenerative joint disease

Question 17

What is osteoarthritis?

Answer 17

involves cartilage and bone destruction accompanied by osteophyte formation and other changes to the joint that result in pain and limited mobility

Question 18

Compare/contrast osteoarthritis and RA in terms of site affected

Answer 18

OA: joint localization, RA: articular, systemic and extra-articular manifestations

Question 19

Compare/contrast OA and RA in terms of pathogenesis

Answer 19

OA: biomechanical; leads to loss of cartilage matrix, RA: autoimmune response and extra-articular manifestations

Question 20

compare/contrast OA and RA in terms of sxs

Answer 20

OA: pain, stiffness > 20mins, limited motion, RA: pain, joint swelling, stiffness >1 hours, limited motion

Question 21

Can you use RA drugs for OA?

Answer 21

NO!

Question 22

compare/contrast RA and OA in terms of inflammation

Answer 22

OA: usually limited, may be present in advanced disease; RA: chronic

Question 23

compare/contrast RA and OA in terms of osteophytes

Answer 23

OA: present, RA: absent

Question 24

compare/contrast Oa and rA in terms of rheumatoid factors

Answer 24

OA: absent, RA: usually present

Question 25

non-pharmacologic treatment of OA

Answer 25

weight loss, exercise, patient education

Question 26

Pharmacologic treatment of OA

Answer 26

analgesic (acetaminophen), NSAIDs, intraarticular corticosteroids

Question 27

Step 1 of progressive therapy of OA

Answer 27

Acetaminophen: no inflammation = prn, routine dosing if inflammation

Question 28

Step 2 of progressive therapy of OA

Answer 28

NSAID: if inflammation or tylenol is inadequate

Question 29

Step 3 of progressive therapy of OA

Answer 29

intraarticular corticosteroids: persistent sxs in one or a few joints (don?t use chronically - more than 2 yrs)

Question 30

what should you monitor with acetaminophen use?

Answer 30

hepatotoxicity

Question 31

how should NSAIDs be prescribed at first?

Answer 31

titrate up to effect and adverse event monitoring, naproxen or ibuprofen? Try either - can switch

Question 32

NSAIDs are a bad choice for pts with

Answer 32

upper GI issues, Asa for cardioprotection, warfarin users, increased CVD risk, renal insufficiency

Question 33

labs for NSAID chronic use monitoring

Answer 33

yearly CBC, BUN, serum creatinine, AST

Question 34

effects of NSAIDs on warfarin

Answer 34

blunt warfarin, increase antiplatelets - could bleed out!

Question 35

If oral agents are contraindicated, what are substitutes for NSAID therapy?

Answer 35

topical NSAID, capsaicin

Question 36

problems with topical NSAIDs?

Answer 36

variable length of effectiveness, local skin reactions (diclofenac)

Question 37

uses for capsaicin

Answer 37

mild to moderate effect for hands and knees

Question 38

who should get intraarticular corticosteroids?

Answer 38

pts with one or a few joints involved not adequately controlled, NSAIDs contraindicated

Question 39

how are itnraarticular steroids dosed?

Answer 39

depending on joint size (20, 40, 60mg)

Question 40

what joints are most effected by intraarticular steroids?

Answer 40

hips and knees

Question 41

what is glucosamine?

Answer 41

isolate of chitin or synthetic used in synthesis of articular cartilage

Question 42

what is chondroitin?

Answer 42

cow trachea or synthetic, this is glycosaminoglycan

Question 43

watch out for this with glucoasmin use?

Answer 43

increased insulin resistance

Question 44

watch out for this with chondroitin use?

Answer 44

looks like heparin, careful with hemodynamically touchy pts

Question 45

true or false: glucosamine or chondroitin alone may reduce risk of OA

Answer 45

TRUE

Question 46

True or false: glucosamine and chondroitin are safe to use and well tolerated

Answer 46

TRUE

Question 47

true or false: chondroitin alone may reduce pain in OA

Answer 47

TRUE

Question 48

true or false: glucosamine alone may reduce pain in OA

Answer 48

TRUE

Question 49

MOA of capsacin

Answer 49

activates TRPV1 cation channels on nociceptive nerve fibers, increases release of substance P and then levels dramatically drop

Question 50

ADR of capsaicin

Answer 50

burning of skin!

Question 51

Is capsaicin useful on larger joints?

Answer 51

no

Question 52

What are salonpas and bengay based off of?

Answer 52

methyl salicylate or oil of wintergreen - all products have diff ingredients