TMD Tx Flashcards
ACUTE PAIN CAN BECOME CHRONIC IF IT LASTS
MORE THAN ____-_____ months OR THE TIME IT
WOULD TAKE CONNECTIVE TISSUE TO HEAL
3 TO 6 MONTHS
CHRONIC TMD PAIN SYNDROMES LAST AT MORE THAN ___ MONTHS
6 months
What are the 4 COMMON CO-EXISTING PAIN CONDITIONS?
- TMD
- FIBROMYALGIA
- HEADACHES (MIGRAINES, TENSION-TYPE, AND TAC’S)
- IRRITABLE BOWEL SYNDROME (IBS)
What is the max dose of tylenol for chronic pain?
3000 mg/day
What is the typical max dose of tylenol without chronic pain?
4000 mg/day
PARACETAMOL (GENERIC IN SOME FOREIGN COUNTRIES)
* APAP (ACETYL-PARA-AMINOPHENOL)
* NO ANTI-INFLAMMATORY EFFECTS
* MINIMAL INCREASED RISK OF BLEEDING
* OVERDOSE: HEPATOTOXICITY
Acetaminophen
What is max rec dose for Ibuprofen?
3.2 g
What is max rec dose for aspirin?
4 g
Percocet and Roxicet contains what drugs?
Tylenol and Oxycodone
Vicodin and Norco contain what drugs?
Tylenol and Hydrocodone
Advantages of ______ opioids
* MORE CONSISTENT ANALGESIA
* FEWER ADVERSE EFFECTS
* MORE TOLERANCE TO ADVERSE EFFECTS
* BETTER SLEEP ➔BETTER DAYTIME FUNCTION
* LESS EUPHORIA, ADDICTION, DIVERSION
Long acting opioids
- AT ____ dose of NSAIDs
- ANTIPYRETIC EFFECTS
- ANALGESIC EFFECTS
Low dose
- AT ____ DOSES of NSAIDs
- MORE ANTI-INFLAMMATORY EFFECTS BESIDES MENTIONED EFFECTS
High dose
- OTC 200MG
- RX 400MG, 600MG, 800MG
- MAX DOSE: 3200 MG PER DAY IN DIVIDED DOSES
- TOXICITY: GI ULCER
- TO REACH ANTI-INFLAMMATORY EFFECTS MUST USE 1800MG-3200MG/DAY IN DIVIDED DOSES
IBUPROFEN (MOTRIN®, ADVIL®)
- MAX DAILY DOSE: 1500 MG PER DAY IN DIVIDED DOSES
- TOXICITY: GI ULCER
- COMBINATION WITH PPI ESOMEPRAZOLE TO MINIMIZE THE GI DAMAGE (BRAND NAME VIMOVO®)
NAPROXEN (ALEVE® 220MG OTC)
- SELECTIVE COX 2 INHIBITOR
- 100MG OR 200 MG TWICE DAILY
- AVOID IF PATIENT HAS SULFA ALLERGY
CELECOXIB (CELEBREX®)
The following are _____
USED FOR MUSCLE OR TMJ PAIN
(I.E. ARTHRITIS)
NSAIDS: COMPOUNDED
10% OR 20% INDOMETHACIN
10% OR 20% IBUPROFEN
10%, 15% OR 20% KETOPROFEN
3%, 5%, OR 10% DICLOFENAC
USED FOR MUSCULOSKELETAL PAINS
NSAID WITH MUSCLE RELAXANTS
1% FLEXERIL WITH10% KETOPROFEN/10% IBUPROFEN
1% DICLOFENAC SODIUM GEL(VOLTAREN) RX OR OTCThis Photo by Unknown Author is licensed under CC BY-SA
Topical NSAIDs
ADRs of ______
* RESPIRATORY DEPRESSION
* NAUSEA/ VOMITING
* SEDATION
* DIZZINESS
* CONFUSION
* PRURITUS
* CONSTIPATION
Opioids
- BINDS TO CNS OPIOID RECEPTORS AND INTERRUPTS WITH NOCICEPTIVE TRANSMISSION
- INHIBITS THE REUPTAKE OF SEROTONIN AND NOREPINEPHRINE
- DOSE TITRATION IS NEEDED
- ABRUPT D/C IS NOT RECOMMENDED
Tramadol
PERIPHERAL DAMAGE
* DIABETIC NEUROPATHY
* POST-HERPETIC NEUROPATHY
* IMMUNOSUPPRESSANT THERAPY FOR
CANCER TREATMENT
CENTRAL DAMAGE
* POST- STROKE
* SPINAL OR OTHER CNS DAMAGE
* TRAUMA
* MALIGNANCY
* MULTIPLE SCLEROSIS- CAN LEAD TO
TRIGEMINAL NEURALGIA
Neuropathic pain
MOA
* INHIBITION OF NOCICEPTIVE PATHWAY
* INHIBITION OF NOREPINEPHRINE AND SEROTONIN REUPTAKE
* INCREASE THE SYNAPTIC CONCENTRATIONS OF 5HT3 & NE
* POTENTIATE THE ANALGESIC EFFECTS OF OPIOIDS
* SODIUM CHANNEL BLOCKING EFFECTS (LIKE LOCAL
ANESTHETICS)
TRICYCLIC ANTIDEPRESSANTS (TCAs)
- INHIBIT SEROTONIN AND NOREPINEPHRINE REUPTAKE
- LOWER DOSES NEEDED FOR NP THAN DOSES IN DEPRESSION TREATMENT
- DULOXETINE (CYMBALTA)
- VENLAFAXINE (EFFEXOR)
- DESVENLAFAXINE (PRESTIQ)
SELECTIVE SEROTONIN NOREPINEPHRINE
REUPTAKE INHIBITORS (SNRIS)
FREQUENTLY ARE USED AS ADJUNCTIVE
MEDICATION IN THE TREATMENT OF ACUTE LOW BACK PAIN. THEIR
USE IN CHRONIC PAIN IS MORE LIMITED
*ALL MUSCLE RELAXANTS CAN CAUSE DIZZINESS AND SEDATION
*DIFFERENT AGENTS HAVE DIFFERENT MECHANISM OF ACTION
MUSCLE RELAXANTs
