m/s drug treatments

Ibuprofen best for treating

best for treating OA of the knee, hip, and/or hand

Not necessarily a great med for the population of pts with OA though

Naproxen

best for pts needed extended relief b/c works longer than ibuprofen

APAP

not effective for treating inflammation, also not effective at treating muscle injuries because it isn’t an NSAID and only inhibits PGs centrally and not peripherally.

Preferred treatment for pts with OA high-risk patients (>75, history of CAD/HTN/GERD)

Ineffective for low back pain

If pt can’t take NSAIDs, APAP + RICE

APAP w/ Naproxen

new FDA approved drug with two MOA

Diclofenac 1% Gel Dosing and MOA

Dosing: 2g upper/ 4g lower, read dosing card on box, max=32g/day,

MOA: same as PO NSAIDs, not effective at treating inflammation

Diclofenac Gel 1% Pros 2/cons 4

P: minimal side effects, more effective and preferred over other ts

C: must be applied 3-4x/day, may take up to 7 days to work, should not apply to more than 2 body areas at one time, DO NOT USE WITH ASA ALLERGY

Camphor dosing and MOA

Dosing: not for children less than 2, should be used cautiously in children regardless

MOA: Analgesic, anesthetic, and antipruritic at concentrations less than 3%, Counterirritant (3-11%), Rubefacient when applied vigorously

Camphor Side effects

Cool sensation followed by warmth,

skin irritation,

greasy,

CNS toxicity if eaten,

High dose= N/V, HA, dizziness, delirium, convulsions, coma, death

Camphor Pro 2/Con 1

P: minimal systematic absorption, effective for temporary pain relief

C: Pregnancy

Camphor treats

temp. relief of minor/mod. aches and sprains and/or muscles and joints

Diclofenac 1% gel treats

Only FDA approved for OA

Menthol treats

Mild to mod. pain

Menthol dosing and MOA

Dosing: can be used for kids less than 2,

MOA: Anesthetic and antipruritic, counterirritant= 1.25% C, stimulates cutaneous receptor TRPM8 producing a cold sensation followed by warmth

Menthol side effects

well-tolerated, skin irritation, cool then warm sensation, greasy

Menthol Pro 4/Cons 1

P: topical application with local effects, limited DDIs, effective at temporary pain relief (use up to 7 days), pregnancy/bf

C: 3-4x/day application

Methyl Salicylate treats

relief of minor pain/aches, minor anti-inflammatory effects due to absorption

Methyl Salicylate Dosing and MOA

Dosing: more toxic than others, Do not use in children less than 6, not for people with ASA allergy

MOA: counterirritant and rubefacient =HOT, Topical NSAID: inhibits both C and P PG synthesis and site of application

Methyl Salicylate side effects

produces a “hot” feeling, localized skin rash/irritation, may cause burns, blistering, and thermal hyperglasia, if used with heat or exercise→ 3x increase in systemic absorption= neurotoxicity

Methyl Salicylate Pro 2/Cons 6

P: effective at providing temporary relief. Use up to 7 days. Available as a combo product with different concentrations

C: Pregnancy/bf, DDIs similar to ASA, >5% concentration requires child proof packaging, 10-20% absorption if covered with dressing, very dangerous in children less than 6, don’t use with ASA allergy

Trolamine Salicylate treats

mild/moderate OA

Trolamine Salicylate brand

Aspercreme

Trolamine Salicylate dosing and MOA

Dosing: +2 y.o., 10-15% C applied 3-4x/day, not for people with ASA allergy

MOA: Topical NSAID, absorbed through the skin and concentrates the synovial fluid reducing pain at the site by inhibiting P PG synthesis

Trolamine Salicylate Pro 4/Cons 2

P: good option for pts who don’t like smell/counterirritants, low systemic absorption, slightly less effective than PO NSAIDS but with minimal side effects, pregnany/bf

C: no recent studies, max 7 day use

Capsaicin (Zostrix, Capzasin) treats

mild/mod. pain, chronic treatment of OA, RA, neuropathy, back pain

Capsaicin MOA

MOA: counterirritant, stimulates TRPV1 and release of substance P inducing burning/warmth feeling, goes away in 1-2 weeks. Chronic pain reliever: chronically depletes substance P from sensory neurons both P and C. No anti inflammatory effects

Capsaicin Side effects

Strong burning feeling (transient), cough, runny nose, sneezing if inhaled, skin irritation

Capsaicin Pro 3/Cons 3

P: acts locally, can be used chronically, Pregnancy/bf

C: adherence failures, does not treat inflammation, apply using gloves

Lidocaine 4% treats

minor pain, neuropathic pain

Lidocaine 4% dosing and MOA

Dosing: roll-on, cream, patch ointment, apply to intact skin, max 7 days use

MOA: topical anesthetic/analgesic, blocks the initiation and conduction of nerve impulses by decreasing the membrane permeability to sodium ions

Lidocaine 4% side effects

numbness, blistering, redness, skin irritation, if ingested or high con.= CV and CNS risks

Lidocaine Pro 5/Cons 2

P: patches can be cut, cheaper alternative to Rx, few DDIs, available as combo product, pregnancy/bf

C: 3-4x/day application, does not treat inflammation

Glucosamine and Chondroitin treats

OA

Glucosamine and Chondroitin Doing and MOA

Dosing: G 1500mg/ C 1200mg, don’t recommend to pts with shellfish allergy

MOA: Glucosamine-Mucopolysaccharide (chondrocytes→ cartilage and synoviocytes→ synovial fluid and hyaluronic acid, inhibits matrix metalloproteinase and modulates inflammatory cytokine activity) Chondroitin- chondroprotectant

Glucosamine and Chondroitin Pro 1/Cons 4

P: usually well tolerated

C: pregnancy/bf, not regulated, takes 6-8 weeks to work, possible DDIs with warfarin (might increase blood glucose)

Drugs that shouldn’t be recommended to pts with ASA allergy

NSAIDS, ASA, Diclofenac, Methyl Salicylate, Trolamine Salicylate

Drugs that aren’t for young children

Camphor (less than 2 y.o.), Methyl Salicylate (less than 6 y.o.), Trolamine Salicylate (less than 2 y.o.), ibuprofen (less than 6mths), Naproxen (12+), ASA (never)

Counterirritant drugs (4)

Camphor, Menthol, Methyl Salicylate, Capsaicin