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Clinical part B > Pain part 2 > Flashcards

Pain part 2 Flashcards

1
Q

what are skeletal muscle relaxants and examples

A

act predominantly within the CNS to relieve pain associated with skeletal muscle spasms
methacarbamol
chlorzoxazone
orphenadrine

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2
Q

methocarbamol MOA

A

unknown
causes skeletal muscle relaxation
doesnt work directly on muscle

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3
Q

indication for methocarbamol

A

treat acute, painful, musculoskeletal muscle spasms

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4
Q

methocarbamol onset and use

A

12-24 hours

use limited due to side effects

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5
Q

orphenadrine indication

A

treat painful muscle spasms due to acute musculoskeletal conditions

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6
Q

orphenadrine onset of action and use

A

more than 24 hours

use limited due to side effects

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7
Q

hwo does chlorzoxazon work

A

central acting properties doesnt act on the muscles

decreases muscle spasm to decrease pain and increase mobility in musculoskeletal conditions

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8
Q

onset and use of chlorzoxazone

A

12-24 hours

nto used to side effect of hepatotoxicity

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9
Q

common side effects of skeletal muscle relaxants

A

drowsiness
dizzines
headache
light headed

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10
Q

common contraindications of skeletal muscle relaxants

A

pregnancy

anticholinergic activity therefore gluacoma, porstate hypertrophy, arrhythmias etc

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11
Q

side effect of methocarbamol and chlorzoxazone

A

urine discoloration
metho - black, blue, green
chlor - orange, purple, red

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12
Q

skeletal muscle relaxant drug interactions

A 
other Ach agents
CNS depressants 
MAO inhibitors 
alcohol 
all CMS depressants
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13
Q

difference between anesthetic and analgesic

A

analgesic raises pain threshold at terminal nerve endings

anesthetic blocks pain receptors to numb the area

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14
Q

whats the counterirritant effect of topical

A

stimulates cutaneous sensory receptors causes you to feel that sensation instead of the more intense pain
known as paradoxical pain
adjuvant therapy
placebo effect from the odor or cooling/warming effect

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15
Q

analgesic with cooling effect

A

methyl salicylate
capcaicin
trolamine salicylate

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16
Q

analgesic wiht cooling effect

A

menthol

camphor

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17
Q

which product has no odor

A

trolamine salicylate

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18
Q

advice for external analgesic use

A 
dont apply to wounds or damaged skin 
dont bandage 
avoid contact with eyes
not for children under 2
dont use more than 4 times a day 
dont apply heat with it
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19
Q

avoid use of methyl salicylates and trolamine salicylate in

A

people taking anticoagulants
allergic to salicylates
caution for salycylate sensitive asthmatics

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20
Q

are external analgesics any good

A

lack scientific evidence
more just a placebo due to the subjective nature of pain
doesnt alter underlying process more symptomatic relief or a distraction

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21
Q

what is tachyphylaxis and what does it occur in

A

effect diminishes with repeated applications

capsaicin

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22
Q

capsaicin MOA

A

depletion of substance P which normally allows the transmission of pain impulses in sensory neurons
reduces the pain not the inflammation

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23
Q

onset of capsaicin

A

pain relief in 14 days but can be delayed by 4-6 weeks

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24
Q

indication for capsaicin

A

osteoarthritis pain
postherapeutic neuralgia
low back pain

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25
Q

specific instructions for capsaicin

A

application less than 3 times a day may not provide relief and may cause the initial burning sensation to persist
continued application for 3-4 weeks need for optimal response, burning sensation will diminish
discontinue if doesnt improve in 28 days

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26
Q

CI for topical NSAIDs

A

same as oral

27
Q

OTC topical NSAID use and effectiveness

A

short term 7 days

similar pain relief to oral but less GI effects

28
Q

application of diclofenac diethylamine gel

A

3-4 times a day

extra strength every 12 hours

29
Q

characterization of back pain (3)

A 
acute = <4 weeks 
subacute = 4-12 weeks 
chronic = >12 weeks
30
Q

what is the cause of acute low back pain

A

mechanical

results from a sprain or strain of muscles or ligaments that support the lumbar spine

31
Q

causes of acute low back pain

A 
repetitive or awkward use of lumbar muscles 
improper lifting 
strenuous work 
improper posture 
excessive tension from stress 
improper shoes
32
Q

less common causes of low back pain

A 
inflammatory or traumatic injuries to joints and ligaments
disc injury 
neurological involvement 
arthritis
malignancy and infection
33
Q

what age is low back pain the most common

A

45-64 years old

34
Q

symptoms of low back pain.. duh

A

muscle ache to spasem

low back, buttocks, posterior thigh

35
Q

risk factors associated with lower back pain

A

age - not common in children
occupation
posture - lying

36
Q

red flags for abck pain

A 
pain middle-upper part of the back 
present for more than 5 days 
bladder/sexual dysfunction 
fever/chills
vertebral tenderness 
>50 or <20 years old - if cant be explained 
constant pain, no relief with postural change 
loss of movement/motion 
unexplained weight loss 
chronic liver disease
inflammatory arthritis 
fibromyalgia 
gout 
tingling/numb legs 
long term steroid use
history of malignant disease (cancer) 
high risk for fractures 
no response after 1 month treatment 
herniation 
cauda equina syndrome 
compression fracture
sciatica
visceral pain
37
Q

treatment goals for lower back pain

A 
symptom relief 
improve functional ability 
decrease long term disability 
prevent recurrence
prevent work absence
promote healthy behavior
38
Q

what is better for back pain then just bed rest and pain meds

A

returning to activity asap

39
Q

non pharms for backpain

A 
cryotherapy(ice) first 24-48 hours
thermotherapy (heat)
exercise 
rest only if essential 
control anxiety or depression
40
Q

role of skeletal muscle relaxants in lower back pain

A

not first line
maybe sedative agent
short term use only, 2-3 days effects last no longer than 4-7 days otherwise may develop dependence

41
Q

recommended pharmacological approach for acute back pain

A

oral analgesics

NSAIDS for inflammation but in no inflammation the acetaminophen preferred because safer

42
Q

how should oral analgesics be dosed in back pain

A

scheduled

not as needed

43
Q

prevention of back pain

A

program for flexibility
aerobic conditioning
proper posture
weight loss

44
Q

monitoring for back pain

A

improve in 7-10 days
should be able to continue ordinary activities
recover in a month

45
Q

define a strain

A

muscle fibres are pulled apart causing pain, reduced movement, and sometimes swelling

46
Q

define contusion

A

damage to blood vessels in muscles followed by bleeding, bruising

47
Q

what is tendonitis

A

due to chronic overuse of tendons

48
Q

what is tenosynovitis

A

tendon is irritated and inflammed

sometimes a crackling sound when moving

49
Q

difference between tendons and ligamnets

A

tendons join muscles to bone

ligaments join bones to other bones

50
Q

characterization of sprains

A

1st degree - excessive stretching
2nd degree - partial tear
3rd degree 0 complete tear of tissue

51
Q

red flags for sprains/strains

A 
severe pain or weakness in any limb 
deformed joint 
abnormal joint movement 
systemic symptoms 
fracture suspected
increased intensity of pain 
inability to bear any weight on the limb 
pain lasting longer than 2 weeks 
swelling continues more than 14 days after PRICE therapy
52
Q

treatment goals for sprains/strains

A 
minimize swelling 
prevent long term diability 
optimize ability to perform daily activities 
minimize adverse drug reactions 
prevent re-injury
53
Q

non pharms for a strain

A

PRICE = protection, rest, ice, compression, elevation
heat
rehabilitation

54
Q

pharmacological treatment for a strain

A

oral analgesic

exteranal analgesic

55
Q

treatment for acute injury

A 
RICE
rest
ice for 20 min every 2 hours for 48 hours to reduce inflammation 
compression for swelling
elevation to reduce swelling
56
Q

what does no h.a.r.m stnad for

A 
for 24-48 hours no 
heat - increases bleeding
alcohol - increases swelling
running - exercise worsens 
massage - increase swellign and bleeding
57
Q

roles of cryotherapy in the acute stage

A

decreases metabolism and inflammation
slows nerve conduction velocity
vasoconstriction decreases edema

58
Q

problem with excessive icing

A

reduces vascular clearance of inflammatory mediators and causes further tisue damage

59
Q

who should use cryotherapy wiht caution

A

urticaria

renoids disease

60
Q

applicatin of cryotherapy

A

gel packs, peas etc with a wet cloth placed between the skin and ice to prevent frostbite
apply 20 min or until skin feels numb every 2 hours untill swelling decreases, up to 48 hours

61
Q

purpose of heat in subacute phase of injuries

A

vasodilation will make bleeding worse
increased tissue perfusion of oxygen and nutrients
helps with removal of carbon dioxide, waste, and pain mediators
relaxes muscles

62
Q

who should heat be avoided in

A 
urticaria 
peripheral vascular disease, neuropathy (lost feeling dont want to burn) 
rhuematoid arthritis (enzymes that cause damage increase)
63
Q

what do heat wraps contain and how do they work

A

carbon and iron

once exposed to oxygen causes oxidation so heat released

64
Q

monitoring for sprain

A

swelling and discomfort subside in 48 hours
should be able to move ankle
therapy for 7-10 days

Clinical part B (15 decks)

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