Pain management and treatment for MSK Flashcards
What are the different painkillers?
- NSAIDs
- Corticosteroids
- Opioids
- DMARDs
- Biologics
- Gabapentin
- Amitriptyline (back pain)
What are the doses available for Co-codamol?
- 8 mg/500 mg
- 15 mg/500mg
- 30 mg/500mg
What are the NSAIDs?
Aspirin
Ibuprofen
Naproxen
Diclofenac
What do NSAIDs do?
inhibit COX1 and COX2 which reduces prostaglandins and arachidonic acids
What does COX 1 do?
- platatel aggregation
- BF in kidney
- production of mucus
What does COX2 do?
- inflammation
What are cautions for NSAIDs
GI and renal impairment
What is the non-analgesic use of Aspirin?
used in MI for anti-platelet
When is ibuprofen commonly used?
MSK, postoperation analgesia and dental pain (good inflammatory)
When is diclofenac used?
MSK, goat and post-op
What is the gel form of diclofenac?
voltarol
When does aspirin bleeding risk outweigh benefit
if over 60
What are the drug interactions of NSAIDs?
1) increased bleed risk if with another NSAID
2) increased GI bleed with anticoagulants or anti-depressant
3) reduces effectiveness of antihypertensives
4) reduced effectiveness of diuretics
5) methotrexate (increases toxicity)
When should methotrexate not be prescribed?
women of child bearing age or man who is likely to have child
When are NSAIDs contraindicated?
- GI bleed or ulcer
- children due to Reyes
- taking anticoagulants
- caution with renal impair, HF or inc BP
- previous hypersensitivity reaction
- caution in pregnancy (ibuprofen can close PDA)
What is Stevens-Johnson Syndrome?
- hypersensitivity reaction to penicillin or sulphonamides
What are the selective COX inhibitors?
celecoxib (OA or RA)
Etoricoxib (prescribed in OA or RA)
How is allopurinol used?
treatment for goat
When are corticosteroids used?
(more potent than NSAIDs)
- severe conditions
- when NSAIDs contraindicated
- used in combination with opioid (can use lower doses so lower SE)
What is the biggest side effects of glucocorticoids?
osteoporosis (which increases fracture risk)
- inhibit osteoblasts and activate osteoclasts (more bone resorption)
What are the DMARDs?
methotrexate
leflunomide
infliximab (binds to TNF-alpha)
How is goat managed?
- colchicine
- allopurinol (dec uric acid)
- NSAIDs
- Prednisolone
- IA
Treatment for osteoarthritis?
Capsaicin gel
