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35 Cards in this Set
- Front
- Back
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OA non-drug tx (6)
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1)exercise
2)heat 3)ultrasound 4)TENS 5)assist devices 6)joint protection |
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OA drug tx algorithm (6)
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1)APAP 4g/d
2)topical capsaicin 3)glucosamine (watch for shellfish allergy) If no response 4)NSAIDs 5)narcotic analgesics/hyaluronate injexns 6)eval for surgery |
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NSAIDs general info (6)
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1)use after simple analgesics fail to decr pain (simple=APAP and OTC doses of ibu)
2)all are comparably effective in pain reduction and modifying inflammation 3)base on MD/pt pref 4)do trial of 2-3wks @ adequate dose 5)if fail go to another class 6)NO benefit of combine NSAIDs w/ ASA |
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NSAIDs indications (7)
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1)OA/RA/juvenile RA
2)gouty arthritis 3)ankylosing spondylitis 4)mild-mod pain 5)fever 6)dysmenorrhea 7)idoipathic menstruation |
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Risk factors for GI bleed w/ NSAID (7)
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1)over 65yo
2)prior hx of GI bleed 3)concomitant steroids 4)ASA or warfarin tx 5)NSAID under 3mon 6)CV/renal/hepatic disease 7)HTN |
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NSAIDs and GI
a)if low GI risk b)if high GI risk c)if no heart disease (2) |
a)consider traditional NSAID
b)traditional NSAID w/ PPI or misoprostol c)consider COX-2 if NO heart disease c)or mobic, etodolac, nabumetone "COX 1.5" |
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NSAIDs and GI
a)high GI risk (7) b)low GI risk (6) |
a)Fenoprofen
a)Flurbiprofen a)Meclofenamate a)Oxaprozin a)Piroxicam a)Indomethacin a)Ketorolac b)Cox-2's b)Lodine b)Ibuprofen b)Mobic b)Nabumetone b)Sulindac |
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REALLY bad time to use NSAID (3)
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1)NO NSAIDs b4/after CABG
2)can cause GI bleeds 3)can incr MI/CVA |
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Back Pain def's (6)
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1)most have first ep by 20-55yo
2)refers to non-specific (no cause makes up 90% of cases) 3)acute= low back, not past knee for less than 4wks 4)chronic=low back, not past knee for over 4wks 5)acute sciatica=lower back pain past knee under 4wks 6)chronic sciatica=lower back pain past knee over 4wks |
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Back Pain general tx guidelines (8)
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1)most will improve within 2wks; s/sx free in 12wks
2)over 50% will reoccur after 1st ep within few years 3)heat pack 4)emphasize limited bed rest, early ambulation/stretching 5)use APAP/Anti-inflam 6)muscle relaxants helpful for FEW DAYS (drowsy so use in short term) 7)narcotics rarely indicated (2/3rd line if nonopioids are NOT effect/tolerable) 8)preach benefits of massage, acupuncture, yoga, etc |
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NSAIDs and pain and cause for referral (5)
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1)fever over 38C
2)unrelenting night pain or pain @ rest 3)pain w/ distal numbness or weak legs 4)loss of bowel/bladder control 5)progressive neurologic deficit |
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NSAIDs
a)CI (3) b)class ADRs (4) c)pt consult (2) d)class interaxns (5) |
a)renal
a)HTN/CHF a)bleed/PUD b)GI cramp/indigestion b)diarrhea/constipation b)edema b)RASH c)alcohol/ASA c)may take w/ food/milk if GI upset d)Li d)warfarin d)oral hypoglycemics d)MTX d)ACEI/BB/diuretics effectiveness are decr by NSAIDs |
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Anaprox/Naprosyn
a)indications (2) b)PK (3) |
a)OA/RA
a)gout b)Anaprox peak is 1-2h b)Naprosyn peak is 2-4 b)Naprosyn decr dose in hepatic impair |
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Motrin
a)max dose b)indications (2) |
a)3200mg/d
b)OA/RA b)primary dysmenorrhea |
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Daypro
a)generic b)dosing c)interaxns (2) d)consult |
a)oxprazosin
b)qd c)ASA, warfarin c)diuretics d)take w/ food/milk |
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Lodine
a)generic b)dosage forms c)consult |
a)Etodolac
b)watch dosage for for 400/500mg (XL and IR have these strengths) c)take w/ food/milk; do NOT crush |
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Voltaren
a)generic b)indication c)CI/precautions (4) d)ADR (2) |
a)diclofenac
b)OA/RA c)renal c)HTN/CHF c)bleed/PUD c)HEPATOXICITY d)GI cramp/indigestion d)diarrhea/constipation |
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Clinoril
a)generic b)dosing/PK (2) c)CI/precautions (4) d)ADR (3) e)other |
a)sulindac
b)dose reduce in hepatic impair b)prodrug c)HTN/CHF c)bleed/PUD c)elderly c)has SULFA d)GI d)rash d)dizzy e)RENAL SPARING******* |
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Feldene
a)generic b)dosing c)CI/precautions (5) |
a)prioxicam
b)qd c)renal c)HTN/CHF c)bleed/PUD c)elderly c)reduce dose in hepatic impair |
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Indocin
a)indications (2) b)drug interaxns (3) c)consult (2) |
a)OA/RA
a)gout b)Li b)BB b)diuretics c)alcohol c)take w/ food/milk or antacids |
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Ketorolac
a)generic b)dose limit c)CI (4) d)consult |
a)Toradol
a)5 day limit b)renal b)HTN/CHF b)bleed/PUD b)elderly c)take w/ food/milk |
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Nabumetone
a)generic b)indications c)PK d)ADR (5) |
a)Relafen
b)OA/RA c)food incr rate of absorption d)ab apin d)diarrhea/constipation d)dyspepsia d)PRURITIS/RASH d)edema |
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Celebrex
a)indications (2) b)PK (2) c)interaxns (3) d)CI/precaution (5) e)ADR (4) f)consult (2) |
a)OA/RA (high dose for RA)
a)acute pain b)2C9 inhibitor b)t1/2= 11h c)ACEI c)Li c)concern for diuretics/fluconazole d)SULFA d)renal d)HTN/CHF d)bleed/PUD d)hepatic e)ab pain, diarrhea e)dyspepsia e)PRURITIS/RASH e)edema f)alcohol f)WITHOUT regard to meals (but can take w/ food/milk) |
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Mobic
a)dosing b)PK c)interaxns (4) |
a)7.5-15mg qd for OA
b)t1/2= 15-20h c)ACEI c)Li c)diuretics c)warfarin***** |
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Disalcid
a)generic b)PK (2) c)CI/precautions (4) d)pt consult (3) |
a)salsalate
b)2 salicylates fused b)less GI irritation**** c)renal c)HTN/CHF c)bleed/PUD c)elderly d)take w/ food/milk d)no ASA d)watch for signs of bleed |
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Arthrotec
a)generic b)CI/precaution (5) c)ADR d)pt consult |
a)diclofenac and misoprostol
b)PREG CAT X**** b)renal b)HTN/CHF b)bleed/PUD b)elderly c)GI- may have to reduce dose if severe d)take w/ food/milk |
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Methotrexate
a)FDA indications (3) b)drug interaxns c)CI d)ADR (3) e)pt consult (3) |
a)various cancers
a)RA a)severe psoriasis b)no NSAIDs during high-dose tx c)preg cat X***** d)stomatitis d)leukopenia d)nausea e)hydrate e)watch sunlight e)periodic lab work |
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Flexeril
a)use b)interaxns c)CI (2) d)ADR (2) e)pt consult |
a)short term
b)CNS depressant c)CHF/acute MI c)arrhythmia/heart conduction abnormal d)drowsy/dizzy/fatigue d)dry mouth e)alcohol |
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Robaxin
a)generic b)indication c)drug interaxns d)ADR (3) e)consult (2) |
a)methocarbamol
b)acute, musculoskeletal pain c)CNS depressant d)dizzy/drowsy d)nausea d)pruritis/rash e)food/milk if needed e)alcohol |
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Norflex
a)generic b)indications (2) c)CI (2) d)ADR e)consult (4) |
a)orphenadrine
b)acute, painful mucloskeletal condition b)LA-bid dosing c)glaucoma c)GI obstruction d)CNS depression e)take w/ food/milk e)alcohol e)driving caution due to blurred vision e)do not crush/chew |
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Skelaxin
a)generic b)indications c)CI/precaution (2) d)ADR (2) e)pt consult (2) |
a)metalaxone
b)acute, mucoskeletal pain c)elderly c)impaired hepatic/renal fxn d)drowsy d)GI e)take w/ food/milk e)do NOT combine w/ alcohol |
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Soma
a)indications b)drug interaxns c)CI d)ADR (3) e)pt consult (2) |
a)acute, musculoskeletal pain
b)CNS depressants c)elderly or debillitated pts d)drowsy d)nausea d)addiction to metabolite e)milk/food if needed e)no alcohol |
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Zanaflex
a)indication b)precautions (2) c)ADR (5) d)pt consult |
a)muscle spasticity
b)hypotension (alpha2 effects) b)liver injury (need LFTs) c)dry mouth c)drowsy/dizzy/hypotension c)bradycardia c)blurred vision c)abnormal LFTs d)food/milk if GI upset |
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Baclofen
a)indication b)drug interaxns c)CI d)pt consult (2) |
a)spasticity (MS); start 5mg tid then titrate
b)CNS depressants c)do not dc abruptly d)drowsy d)no alcohol |
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Zanaflex levels are
a)incr by: (7) b)decr by: |
a)FQs
a)acyclovir a)alcohol a)anti-arrhythmics a)cimetidine/famotidine a)OCs a)clonidine (incr alpha2 effects) b)APAP |
