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85 Cards in this Set
- Front
- Back
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What is MOA for ASA/NSAIDS
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inhibt periperally acting COX-1 and COX -2
and centrally acting mechanismm |
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What does COX-I do?
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synthesis protaglandins
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Why is COX-I good?
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it increases the mucous layer which protects the stomach, and it dialates afferent artery-maintain adequate perfusion
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What happens when COX-I inhibitied
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PG decrease, decrease mucosal layer, and constricts afferent artery in kidney, so kidney retatins (Na/H20)
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Wht does Cox-II do
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sytnehsis protaglandins,
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Why is COX-II bad
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increases inflammation
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What happens when COX-II inhbiited
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PG decrease, resulting in decrease of inflammation
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ASA and platelet activation
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ASA irrevesible binds, inhibiting platlet activation for life--(7-10 days)
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Benfits of ASA
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analagesic, anytpyeric (central mechansism)
COX II--antiinflammatory |
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Side effects of ASA
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GI/irratation damage,
Kidney irration damage Irreversible platlet inactivation |
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How do you manage sides effects of ASA
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Stomach--take with food
Kidneys--take with 6oz water Platelets--be aware of brusing and increasedriske of bleeding |
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What is HF and general result
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HF, ultimately results in inability of the heath provide adequre pumping and blood supply to heart--becuase of this, patietns have fluid overload in many body parts
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What is NSAID/ASA bad for HF patients
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constrict afferent artery of kidney, decreases perfusion (usaually happens from dehydration), body retatins more fluid, adds to fulid overload in HF paitents (makes HF worse)
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Can pt with HF take low dose of ASA
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yes, is accetable
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Most common use for ASA
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cardio-protective activity, as decreases risk of heart attack, stroke,and blood clots
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What is MOA of APAP
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central inhibition of prostaglandin syntheisis of (COX 3)
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Benefits of APAP
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antipyretic, and analgesic, easy on stomach
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Where is APAP metabolized?
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APAP is extenively metabolized in Live and cytochrome P-450
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What is normal mechanism of APAP metabolism
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95% is metabolized by Glucuronidation, adn sulfate conjugation, 5% is by Cytochrome P450--
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Why is Cytochrome P450 bad metabolism
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b/c APAP is broken down into a toxic metabolite,
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Usually what happens to toxic metabolite
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quickly converted to non-toxic by (GSH) Glutathione
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APAP and Alcohol problem
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Problem b/c both are metabolized in liver
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What happens when patient take too much APAP or ETOH with APAP
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the Glucuronidation and fulfate conjugation process become saturated, so more is procress by P450..making more toxic metabolics--if their is not enough GSH to make non-toxic,
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What happens when more toxic metabolites than GSH
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they react with liver cell macromolecules, and result in liver death
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Why is alcohol also a problem with Nsaid and ASA
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1. COX I decrease mucusol layer,
2.NSAIDs ASA, adn Etoh..all acidic, both can lead to irriation, erosion then uleraction 3. inactive platelets which increases risk of bleeding |
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What pathophysiology of HA
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vasodialtion--puts pressure on tissue in brain
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What generally causes tension-type headaches
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stress, anxiety, depression, fatigue
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What is Location of tension HA
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bilateral, over the top of the head, extends to neck and shoulders
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What is nature of tension HA
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diffuse, aching pain (TIGHT, pressing and constricting)
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Onset of tension HA
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gradual
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Duration of Tension HA
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mintutes to days
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What generally cuases Migranes
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stress, fatigue, FASTING, FOOD, meications, and menses
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Location of migraine
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ONE-SIDED
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Nature of migraine
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THROBBING
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Onset of migraine
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Sudden!
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Why does migrane with aura similar to stroke
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b/c of vasoconstriction--difficulty speaking, one-side muscle weakness
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Other symptoms of aura (non-stroke)
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flashing areas, blinds spots
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How long does Aura last
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up to 1/2 hour
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What is duration of migraine
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HOURS-to 2 days!!!
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Location of sinus headache
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face, forehead, and around eyes (peri-orbital)
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Nature of sinus headache
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pressure behind eyes or face, pain in teeth
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Onset of sinus HA
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with sinus symptoms, and prulent nasal discharge
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Duration of sinus HA
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resolves with sinus symptoms
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When a symptoms worse with sinus HA pain
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upon awaking
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What are exculsion for Self-treatment of HA
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Severe head pain, Secondary headache, Symptoms consitant with migraine, but NO dianosis, serious infection headache that persist more than 10 days, history of liver disease or alcoholism
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Until what age should patient avoid ASA adn why
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15, can cause Reye's Syndrome
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Why should older patient and patients with Renal disease avoid ASA and nsaids
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older more sentivie to GI upset, and side effects and all nsaids and asa, metbolized by KIDNEY
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Dosage of Iburofen
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200-400 mg every 4-6 hours
max 1200 |
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Dose of ASA
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650-1000 every 4-6 hrs max 4000
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Dose of APAP
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325-1000 every 4-6 hours max 4000
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Dose of naproxen
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220mg every 8-12 hrs and at least 12 yrs old
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Dose of Ketoprofen
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12.5-25 mg 4-6 hours max 75 and at least 16
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What causes Myalgia
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strains, trauma, overexertion, sysyemic infections, alcohol, statins
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Location of myalgia
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body muscles
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Signs of myalgia
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pain, increase CPK, and rare (swelling)
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Symptoms of myalgia
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dull, constant ache, weakness, and fatigue of muscle
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Onset of myaliga
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trauma-acute
drugs-insidous (gradual) |
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Excerbating factors of myalgia
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contraction of muscle
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Nonpharm for Myalgia
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streching and warming up, elminating cause, rest, RICE,
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Where is location of OA
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Weight-bearing joints, kness, hip, spine, hands
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Signs of OA
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NON-infammatory joints, possible joint deformities
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Symptoms of OA
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Dull join pain relived by REST <20-30 minutes
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Onset of OA
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gradual--over the years
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What causes OA
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softening and destruction of the cartilage between bone
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What are excerbating factors of OA
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obesity, lack of activity, heavy physical activity
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Non-pharm for OA
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continous light-moderate activity, or weight loss, shock absorbing shoes, canes, walkers
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Location of RA
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small joings of fingers, wrists and feet
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Signs of RA
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joint swelling and deformities
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Symptoms of RA
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Pain worse in moring >30 minutes
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Onset of RA
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autoimmune diesase--weeks to months
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What is treatment of choice for OA, should we treat RA
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APAP, b/c no inflammtion, don't treat RA--see a RA
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Exculsion for Self-Treatment of OA, Myalgia
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Severe pain, Serious infection, pain last >10 with.out treatment, pevlic or abdominal pain, visual deformity or <7 yrs
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What is a an OTC recommened for OA
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Glucosamine
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What is Glucosamine and treats
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Building block for cartilage, reduces pain, and reduces the progression of the disease
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What 2 brands are recommend by Glucosamine or what certification
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Kirkland Brand and Nature's way----USP verified
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Who should stay away from Glucosamine
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Diabetics, and allergies to shellfish
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What is non-pharm for tension HA
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relaxation exercise and PT
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What is non-pharm for mirgrane
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regular sleeping, eating schedule, practice methods for coping with stress, avoid wines, cheese, caffiene
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What is RICE
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REst, ICE , compression, adn elevation
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How should one ice
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ASAP to the injured area in 10 minue increments 3-4 times for 1-3 days
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What is compression
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wrap the injured area from the most distal part, if icing at same time wet bandange with cold water
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What is elevation
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elevate the injured area at or above the level of the heat to decrease swelling and relieve pain
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What is heat helpful
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for patients that have NON-INFLAMMATORY pain..reduces pain by increasing blood flow
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How often should heat be used for myalgia and who
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DO NOT USE on recently injured area or INFLAMED--can increase vacodialtion--should be applied every 15-20 minutes 3-4 times a day
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What is onset of relief from Glucosamine
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Take same time each time, may take up a month to see a relief in symptoms----
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