Pharmacology in Ortho Flashcards
What are the two main categories of analgesic medications?
Opioids (narcotics) for moderate to severe pain.
Nonopioids (primarily NSAIDS and Acetaminophen) that are good for mild to moderate pain.
What are common opioids and NSAIDS and what are their effects?
Hydrocodone: onset at 20 minutes, peak at 45 min, duration 4-6 hours.
Aspirin: most commonly used for antiinflammatory effects, also antipyretic and anticoagulation
Ibuprofen (AKA motrin): Same as aspirin but fewer side effects
Naproxen: similar to ibuprofen
How do opioids analgesics decrease pain?
Bind to receptors at synapses in brain and spinal cord, blocking the receiving of signals. Also inhibit the release of pain-mediating chemicals. Cause hyperpolarization in other neurons, raising pain thresholds.
How do NSAIDS exert beneficial effects?
Inhibit the synthesis of prostaglandins by inhibiting the COX enzyme.
What are some problems with long term use of NSAIDS?
Gastric irritation (some prostaglandins protect stomach mucosa). This problem can be dec by taking meds with food.
What effects do NSAIDs have on bone and soft tissue healing?
prostoglandins increase the activity of osteoclasts and osteoblasts that promote new bone formation. There may be a delay in union after fracture or fusions if used immediately following injury. The effect on soft tissues is not clear, but they help pain and swelling so they are useful for Tx soft tissue injuries.
What are COX-2 inhibitors and what are their benefits?
Block the synthesis of prostoglandins more selectively by targeting only COX 2 enzymes (COX 1 are involved in protecting the stomach lining). Celebrex is an example. These meds also don’t effect platelet function so they may not have to be stopped prior to Sx.
What drugs are effective in treating chronic pain?
Traditional antidepressants such as nortriptyline, amitriptyline, paxil, and effexor may help with chronic pain. They may work by prolonging the activity of dopamine, serotonin, or norepinephrine. Some antisiezure drugs may also be helpful, including gabapentin, because they decrease neuronal excitability.
How do glucocorticoids compare to NSAIDs and what are some side effects?
Glucocorticoids are usually much more effective at dec inflammation but they aren’t as safe and can cause serious side effects when used for more than 3 weeks. Side effects include hypertension, muscle wasting, GLUCOSE INTOLERANCE, ulcers, glaucoma, and possibly higher risk of infection (dec immune system). They also inhibit the endogenous production of cortisol, so they should not be stopped abruptly.
How can the catabolic side effects be overcome?
Some instances require long-term use of glucocorticoids (ex: organ replacement). Exercise can help combat muscle wasting.
Is there a limit on the number of glucocorticoid injections that are given to a specific joint?
There should be no more than 4 injections in a 12 month period.
Why are fluoroquinolones potentially harmful to patients with ortho conditions?
These are a group of antibacterial drugs (including cipro and floxin) that are used to treat urinary tract and respiratory infections, amongh other infections. These may cause tendinopathy especially in the achilles and lead to severe tendon rupture.Tendonitis should be brought to the attention of the doctor immediately and exercise using involved tendons should be stopped.
Discuss the pharmacologic strategies for treating RA.
NSAIDs are usually the first line of defense. Glucorticoids may also used DMARDs, including methotrexate and Enebral may be used to help slow or reverse joint disfunction.
What drugs are contraindications to upper cervical manipulation?
anticoagulants (warfarin, heparin) and NSAIDs can increase the risk of vertebral artery damage and bleeding. If all clotting tests are normal, manipulation may be used cautiously.
