non opiates 2 Flashcards
what neurotransmitters are involved in the neuropathic pain pathway?
serotonin (inhibits and promotes pain perception) and norepinephrine (primarily inhibitory)
SNRIs
serotonin-norepinephrine reuptake inhibitors
antidepressant drugs that are used as analgesics
doxepin, milnacipran (fibromyalgia), amitrityline, duloxetine
antiseizure drugs used as analgesics
phenytoin, carbamazepine, pregabalin
which is better for pain: antiseizure drugs, antidepressants
antidepressants - antiseizure drugs focus on Na channels
what did carbamazepine begin treating?
trigeminal neuralgia (better for pain)
do SSRIs help relieve pain?
not as well as SNRIs
how do antiseizure drugs decrease pain experienced?
decrease excitatory transmission, inactivate Na channels (not a class effect)
which antiseizure/antidepressant drugs are albeled for use to decrease pain?
minacipran, gabapentin, duloxetine, carbamazepine, pregabalin
MOA of pregabalin
effect on presynaptic N-type channels, sits in GAMA receptor sites (doesn’t mimic it)
ADRs of pregabalin
dizziness, sleepiness, peripheral edema, weight gain, suicide risk warning (screen for this!), slow taper when d/c
max dose of pregabalin?
450mg/day
Duloxetine MOA
serotonin and NE reuptake
ADR of duloxetine
CNS sxs like sleepiness, fatigue, eadache, nausea, xerostomia, suicide risk warning
Goals of treating osteoarthritis
control pain/swelling, minimize disability, improve QOL, educate on disease mgmt (lifestyle)
what is osteoarthritis AKA?
degenerative joint disease
What is osteoarthritis?
involves cartilage and bone destruction accompanied by osteophyte formation and other changes to the joint that result in pain and limited mobility
Compare/contrast osteoarthritis and RA in terms of site affected
OA: joint localization, RA: articular, systemic and extra-articular manifestations
Compare/contrast OA and RA in terms of pathogenesis
OA: biomechanical; leads to loss of cartilage matrix, RA: autoimmune response and extra-articular manifestations
compare/contrast OA and RA in terms of sxs
OA: pain, stiffness > 20mins, limited motion, RA: pain, joint swelling, stiffness >1 hours, limited motion
Can you use RA drugs for OA?
NO!
compare/contrast RA and OA in terms of inflammation
OA: usually limited, may be present in advanced disease; RA: chronic
compare/contrast RA and OA in terms of osteophytes
OA: present, RA: absent
compare/contrast Oa and rA in terms of rheumatoid factors
OA: absent, RA: usually present
non-pharmacologic treatment of OA
weight loss, exercise, patient education
Pharmacologic treatment of OA
analgesic (acetaminophen), NSAIDs, intraarticular corticosteroids
Step 1 of progressive therapy of OA
Acetaminophen: no inflammation = prn, routine dosing if inflammation
Step 2 of progressive therapy of OA
NSAID: if inflammation or tylenol is inadequate
Step 3 of progressive therapy of OA
intraarticular corticosteroids: persistent sxs in one or a few joints (don?t use chronically - more than 2 yrs)
what should you monitor with acetaminophen use?
hepatotoxicity
how should NSAIDs be prescribed at first?
titrate up to effect and adverse event monitoring, naproxen or ibuprofen? Try either - can switch
NSAIDs are a bad choice for pts with
upper GI issues, Asa for cardioprotection, warfarin users, increased CVD risk, renal insufficiency
labs for NSAID chronic use monitoring
yearly CBC, BUN, serum creatinine, AST
effects of NSAIDs on warfarin
blunt warfarin, increase antiplatelets - could bleed out!
If oral agents are contraindicated, what are substitutes for NSAID therapy?
topical NSAID, capsaicin
problems with topical NSAIDs?
variable length of effectiveness, local skin reactions (diclofenac)
uses for capsaicin
mild to moderate effect for hands and knees
who should get intraarticular corticosteroids?
pts with one or a few joints involved not adequately controlled, NSAIDs contraindicated
how are itnraarticular steroids dosed?
depending on joint size (20, 40, 60mg)
what joints are most effected by intraarticular steroids?
hips and knees
what is glucosamine?
isolate of chitin or synthetic used in synthesis of articular cartilage
what is chondroitin?
cow trachea or synthetic, this is glycosaminoglycan
watch out for this with glucoasmin use?
increased insulin resistance
watch out for this with chondroitin use?
looks like heparin, careful with hemodynamically touchy pts
true or false: glucosamine or chondroitin alone may reduce risk of OA
TRUE
True or false: glucosamine and chondroitin are safe to use and well tolerated
TRUE
true or false: chondroitin alone may reduce pain in OA
TRUE
true or false: glucosamine alone may reduce pain in OA
TRUE
MOA of capsacin
activates TRPV1 cation channels on nociceptive nerve fibers, increases release of substance P and then levels dramatically drop
ADR of capsaicin
burning of skin!
Is capsaicin useful on larger joints?
no
What are salonpas and bengay based off of?
methyl salicylate or oil of wintergreen - all products have diff ingredients
