Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > Pharm - MSK > Flashcards

Pharm - MSK Flashcards

1
Q

Nonopioid Analgesics

A
  • acetaminophen
  • asa and nonacetylated salicylates
  • NSAIDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Adjuvant agents

A
  • corticosteroids

- muscle relaxants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute Pain

A
  • Occurs as a result of injury
    – Self-­limited
    – Adaptive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Chronic Pain

A
  • Pathologic
  • Maladaptive
  • Can be intermittent, persistent or both
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

TX: general approach

A
  1. identify source of pain
  2. assess level of pain
  3. choose therapy based on pain severity/type
  4. use least potent oral analgesic that relieves pain with fewest AE
  5. titrate dose to control pain
  6. use drugs on fixed schedule rather than PRN
  7. assess effectiveness and AE regularly
  8. avoid excessive sedation
  9. change route of admin if necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Analgesic

A
  • effective only against low-to-mod pain intensity (dental pain).
  • Chronic post op pain or pain from inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Antipyretic

A

-reduce fever but not the circadian variation in temp or the rise in response to exercise/ambient temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anti-inflammator

A

NSAIDs play a key role int he tx of MSK disorders (RA and osteoarthritis).
NSAIDS only provide symptomatic relief from disease assoc pain and inflammation and do no prevent disease progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acetaminophen

A
  • analgesic and antipyretic
  • inhibits CNS prostaglandin synthesis (COX-3)
  • hepatotox
  • chronic doses should be less than 4g/day
  • reduce to 2-3g/day if: renal impairment, hepatic disease or excessive alcohol use
  • increase warfarin effect at doses above 2g/day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ASA

A
  • analgesic, antipyretic and anti-inflamm
  • inhibits COX 1 and 2
  • very effective for pain from prostaglandins
  • irreversibly inhibits platelets
  • AE: GI irritation, hypersensitivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Nonacetylated Salicylates

A
  • Choline magnesium salicylate, sodium salicylate, diflunisal
  • similar effects as ASA
  • Less GI irritation
  • reversible platelet inhibition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

NSAIDs

A

-analgesic, antipyretic, and anti-inflamm
-inhibit both COX 1 and 2
-2-3 weeks of therapy is considered sufficient trial
-classes are divided based on chem structure and differ in dose and drug interactions
-selective COX 2 inhibitors to minimize GI tox: celecoxib but may increase risk of CV events
AE: GI, renal insufficiency, CV, drug interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Corticosteroids

A

Adjuvant therapy

  • tx for pts unable to take NSAIDs
  • AE: fluid retention, wt. gain, hperglycemia, CNS stimulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Muscle relaxants

A

Adjuvant therapy
-spasmolytics
-used in combo w/ NSAIDs for pain assoc w/ muscle spasms
-decrease spasms/stiffness in acute or chronic conditions
-AGENTs: baclofen, metaxalone, methocarbmol, carisoprodol, cyclobenzaprine
AE: sedation, drowsy
-interacts w/ alcohol and narcotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Somatosensation

A

Process by which sensory neurons are activated by external stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nociception

A

Process by which neural pathways are activated by tissue damaging substances

17
Q

Pain Pathway

A
  1. Transduction
    - Stimuli into action potentials
  2. Transmission
    - Conduction through nervous system
  3. Modulation
    - Alteration of conduction pathways
  4. Perception
    - Action potential into conscious sensation
18
Q

Afferent Sensory-Pain Fibers

A

Aβ Fibers

  • Heavily myelinated, large diameter = FAST
  • Light Touch and Pressure

Aδ Fibers

  • Lightly myelinated, smaller diameter = Fast (5-20m/s)
  • Intense, stabbing pain. “First” pain.

C Fibers

  • Unmyelinated, small diameter = Slow (2m/s)
  • Burning. “Second”, delayed pain.
19
Q

gabapentin/Neurontin

A

-unclear MOA; binds Ca+2 channels, possibly enhances GABAergic activity (but does not act at GABA receptors), alters concentration or metabolism of cerebral amino acids
-first line for neuropathic and chronic pain
-300mg po qhs x3d, then 300 bid x3d, then 300 tid thereafter with titration up to 3600 qd max. If elderly, start with 100mg instead.
-caution in renal failure or peripheral edema/R-CHF
AE: sedation, dizziness, ataxia, fatigue, peripheral edema/weight gain…

Anticonvusant

20
Q

pregabalin/Lyrica

A

-unclear MOA; binds Ca+2 channels, possibly enhances descending NE and 5HT inhibitory pathways
-first line for FMS, neuropathic and chronic pain
-50mg po tid then titrate to 300 qd max
AE: same caution and SEs as neurontin, but seems to have less

Anticonvulsant

21
Q

TCAs (ami/nortriptyline, desipramine/Norpramine) Tricyclic antidepressants

A
  • unknown; felt to to be central 5HT and NE reuptake inhibitors
  • second line for muscle relaxation
  • 10-25qhs, inc 10-25qwk up to 150qd
  • risk of suicide
  • anticholinergic SEs: mydriasis, dry mouth, blurred viz, dizzy, sedation, constipation, urinary retention; but also many other SEs

Antidepressant

22
Q

duloxetine/Cymbalta

A
  • first line for FMS, MSK pain and neuropathic pain
  • 30mg po qd x1wk then 60 qd max thereafter, ?120 qd
  • risk of suicide, nausea, sedation…
  • caution in adolescents with depression, liver disease

Antidepressant

23
Q

tramadol/Ultram

A

-weak μ agonist, 5HT and NE RI
-first line opioid if considering chronic opioid use
-50-100mg po q6hrs (max 400 qd, 300 qd if elderly)
-caution with other opioids, alcoholics, seizure disorder
AE: vertigo, nausea, constipation, sedation…

acute and chronic pain

24
Q

Topicals

A

lidocaine patch/Lidoderm

  • topical anesthetic (NaCB)
  • first line neuropathic pain
  • 5% patch (may cut) to affected area on 12hrs, off 12hrs
  • very safe

capsaicin/Zostrix

  • second line neuropathic pain
  • 0.025-0.075 % cream applied tid-qid
  • “burns”, warm skin

topical diclofenac/Voltaren Gel

  • topical NSAID
  • first line osteoarthritis, especially small joints
  • small amount to affected area qid
  • caution in CV and GI disease, but very low SEs
25
Q

tizanidine/Zanaflex

A

-central α2 agonist, decreases central and cord motor neuron activity
-first line myalgia and muscle spasm
-2mg po qhs, titrate to 4mg tid max
-no concurrent fluvoxamine or ciprofloxacin
AE: sedation, weakness…

26
Q

hydroxyzine/Vistaril

A

-unclear; anithistamine (dampens c-fibers), CNS depressant effect, muscle relaxer, potentiates opioids
-off label for opioid potentiation and chronic pain (can use less opioid usually)
-for anxiety
-50-100 mg po bid for pain, caution more
-caution with CNS-depressants
AE: sedation, confusion, fatigue…

MSK (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions