Week 9: Sprains & Strains, NSAIDs, Conjunctivitis Flashcards
Contrast between strains and sprains.
Description
Impact
Cause
Location
Symptom
STRAINS: Tear in muscle/tendon (connects muscle to bone)
Impact:
- disrupts movement
Cause
- over-exertion, over-stretching
Location:
- Common in back, shoulder, hamstring
Symptom:
- pain, swelling
SPRAINS: Tear in ligament
Impact:
- disrupts stability
Cause:
- Twisting, falling
Location
- Ankles, knees, wrists, fingers
Symptoms
- pain, swelling, bruising, tenderness
Contrast between Bursitis & Tendinitis
Bursitis: inflammation of the bursa (cushion tendon from the joint)
Impact
- Pain during movement
Cause
- Long pressure resting elbows, kneeling
Location
- Joints (shoulder,knee)
Symptom
- Pain, swelling
Tendinitis: Inflammation of the tendon (connects muscle to a bone or joint)
Impact
- pain during movement
Cause
- improper training technique
Location
- Near joints (shoulder, elbow, knee, ankle)
Symptom
- pain, swelling
Contrast between plantar fasciitis & Shin splint & Stress fracture
Plantar fasciitis: inflammation of periosteum of bottom foot
Impact
- pain while walking
Cause
- long walks, improper footwear
Location
- bottom of hoot
Symptom
- heel pain
Shin Splint: inflammation of muscles and surround tissues of the tibia bone
Impact
- pain while walking, running
Cause
- change in exercise (more running up hills)
Location
- common in lower limbs
Symptom
- Shin pain
Stress fracture: small fracture in bone resulting from repetitive strain (self-limiting)
Impact
- pain during exercise
Cause
- repetitive strain
Location
- Common in lower limbs
Symptom
- Pain during exercise
What are red flags for muscoskeletal injuries?
- Joint injuries with
○ Severe pain
○ Obvious fracture
○ Joint deformity
Inability to bear weight on injured limb
What is the first-line therapy for sports injuries?
What is the full process?
Nonpharmacologic treatments
PRICE
P: protection using splint/brace
R: rest at least 24h
I: Ice 10-30 min q3-6h for FIRST 2 DAYS
C: caution for circulatory disorders
E: elevate above heart level to drain fluid
**for stress fractures, rest and train using low impact activity such as swimming & cycling
AFTER DAY 2:
- apply heat for 20-30 min q2-4h prn
What analgesics can you take for a muscoskeletal injury?
What are some cautions
- Oral: acetaminophen, NSAIDs
- Topical: diclofenac
○ Do not use more than 4 TIMES a day & under heating pads (skin irritation)
Injections: corticosteroids (tendinitis)
- Topical: diclofenac
What is the onset of analgesics? peak effect?
30-60 min
Peak effect 2-3 hours (wait for steady state)
What is the NSAID pharmacology
Inhibits prostaglandin (pain & inflammation) & thromboxane (blood clotting)
What is the difference between COX-1 and COX-2
COX-1: CONSTITUTIVE (always present)
- Helps with:
○ Protect GI mucosa
○ Help platelets aggregate
Vascular homeostasis
COX-2: INDUCIBLE (released in response to injury)
- induces inflammation, pain, and fever
What is the risk associated with COX-2 selective drugs?
Define each drug in terms of NSAID selectivity
Celecoxib (cox-2 selective) causes an increase of heart attacks
- decreased risk of GI side effects
Aspirin: irreversible non-selective NSAID
- cardioprotective at low doses
- increased GI risk
Ibuprofen, naproxen: non-selective NSAID
- decreased risk for CV event
- increased GI risk
Diclofenac, meloxicam: semiselective NSAID
- increased affinity for COX-2 but still some activity for COX-1
- increased CV risk (use w caution)
What NSAID doses are considered prescription
Ibuprofen 400mg+
Naproxen 220mg+
Diclofenac (systemic)
Indomethacin
For people with Kidney problems identify:
The issue
What to look for? (high risk people)
How to reduce?
The issue
- NSAIDs causes renal damage
- pre-renal (dehydration) (can predict + prevent)
- Intra-renal (injury) (unpredictable)
What to look for?
- 65+
- Have hypertension
- Diuretics
How to reduce risk
- Stop NSAIDs if can’t eat/drink
- Avoid NSAIDs for patients on angionestin’s + diuretic
- Use lowest effective dose
For people with stomach problems identify:
The issue
What to look for (high risk)
How to reduce?
The issue
- NSAIDs disrupt the mucous layer
- Makes it more acidic in stomach (inhibit bicarbonate secretion)
- Can cause ulcers (take with TUMS)
What to look for (high risk)
- 65+
- Rheum Arthritis
- Anticoagulants
- H. pylori causes ulcers
- Hematemesis (throwing up blood)
- Dysphagia (troubling swallowing)
How to reduce risk
- NSAIDs + PPI = more helpful
- choose selective COX-2 (celecoxib)
- celecoxib + PPI (if prior bleeding)
For people with heart problems identify:
The issue
What to look for (high risk)
How to reduce risk?
The issue
- NSAIDs increase blood pressure
- ASA and ibuprofen reacts together (take ASA 30 min before or 8 hours after ibuprofen)
What to look for (high risk)
- 65+
- heart failure
- Diabetes
How to reduce?
- choose non-selective NSAIDs
- Add a PPI, misoprostol, or ASA with celecoxib to reduce GI Risk
What layers of the eye can be inflamed if you have pink eye/conjunctivitis?
Explain the condition
All layers (sclera, cornea, conjunctiva)
- usually viral infections
- Often accompanied by watery-mucus discharge and redness
- Does not cause any threat to vision
