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Posterior Long Arm Splinting Medication

  • Author: Lisa Jacobson, MD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Oct 12, 2015
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications. Drugs used for injuries include various NSAIDs and analgesics. The strength of the analgesics depends on the type of pain resulting from the injury.

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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Class Summary

NSAIDs are the drugs of choice for the initial treatment of myofascial pain.

Ibuprofen (Motrin, Advil, Neoprofen, Ultraprin)

 

Ibuprofen inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. It is used to provide relief of cervical myofascial pain.

Indomethacin (Indocin)

 

Indomethacin is thought to be the most effective NSAID for the treatment of ankylosing spondylitis, although no scientific evidence supports this claim. It is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.

Naproxen (Naprosyn, Naprelan, Aleve, Anaprox)

 

Naproxen is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.

Diclofenac (Voltaren, Cataflam XR, Zipsor, Cambia)

 

Diclofenac inhibits prostaglandin synthesis by decreasing COX activity, which, in turn, decreases formation of prostaglandin precursors.

Ketoprofen

 

Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.

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Opioid Analgesics

Class Summary

These medications provide control of moderate to severe pain.

Hydrocodone and acetaminophen (Vicodin, Lorcet, Lortab, Norco, Zolvit)

 

This drug combination is indicated for moderate to severe pain.

Acetaminophen with codeine (Tylenol-3)

 

This drug combination is indicated for mild to moderate pain.

Oxycodone and acetaminophen (Percocet, Endocet, Tylox)

 

This drug combination is indicated for the relief of moderately severe to severe pain. It is the agent of choice for aspirin-hypersensitive patients. Different strengths are available.

Oxycodone and aspirin (Percodan, Endodan)

 

This drug combination is indicated for the relief of moderately severe to severe pain.

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Antihistamines

Class Summary

Antihistamines generally work well for pruritus. The first-generation H1 antagonists (eg, diphenhydramine, hydroxyzine, doxepin, chlorpheniramine, cyproheptadine) are inexpensive and effective in reducing pruritus, but drowsiness and anticholinergic effects can be troublesome. The second-generation antihistamines (loratadine, desloratadine, fexofenadine, cetirizine, and levocetirizine) have much lower sedative effects. Any patient who is taking a medication that has potential sedative effects should be cautioned about driving and operating heavy machinery.

Fexofenadine (Allegra)

 

Fexofenadine is a nonsedating second-generation antihistamine. It is tolerated very well, with a rate of sedation that is not significantly different from that of placebo.

Cetirizine (Zyrtec)

 

Cetirizine selectively inhibits histamine H1 receptor sites in blood vessels, the gastrointestinal (GI) tract, and the respiratory tract, thereby inhibiting physiologic effects that histamine normally induces at H1 receptor sites. Once-daily dosing is convenient. Bedtime dosing may be useful if sedation is a problem.

Diphenhydramine (Benadryl, Altaryl, Anti-Hist, Diphenhist)

 

Diphenhydramine is used for symptomatic relief of symptoms caused by release of histamine. It is the most commonly used first-generation antihistamine, available without a prescription in the United States.

Hydroxyzine hydrochloride (Vistaril)

 

Hydroxyzine hydrochloride antagonizes H1 receptors in the periphery. It may suppress histamine activity in the subcortical region of the central nervous system (CNS).

Loratadine (Claritin, Alavert, Tavist ND Allergy)

 

Loratadine selectively inhibits peripheral histamine H1 receptors. It is tolerated very well, with a rate of sedation that is not significantly different from that of placebo. The once-daily dosing makes it convenient.

Desloratadine (Clarinex)

 

Desloratadine is a long-acting tricyclic histamine antagonist that is selective for H1 receptors. It is a major metabolite of loratadine, which, after ingestion, is extensively metabolized to the active metabolite 3-hydroxydesloratadine.

Levocetirizine (Xyzal)

 

Levocetirizine is an H1-receptor antagonist, an active enantiomer of cetirizine. It is a second-generation prescription antihistamine, available as a 5-mg breakable (scored) tab and a 0.5-mg/mL oral solution.

Chlorpheniramine (Ahist, Aller-Chlor, Chlor-Trimeton, Teldrin HBP)

 

Chlorpheniramine is a first-generation agent that competes with histamine for H1-receptor sites on effector cells in blood vessels and the respiratory tract. It is one of the safest antihistamines to use during pregnancy.

Cyproheptadine (Periactin)

 

Cyproheptadine is a first-generation agent used for symptomatic relief of allergic symptoms caused by histamine release. It prevents histamine release in blood vessels and is more effective in preventing histamine response than in reversing it. It may be useful in patients with syndromes sustained by histamine-producing tumors.

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Contributor Information and Disclosures
Author

Lisa Jacobson, MD Attending Physician, Department of Emergency Medicine, Washington Hospital Center

Lisa Jacobson, MD is a member of the following medical societies: American College of Emergency Physicians, Physicians for Social Responsibility, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jessica Freedman, MD Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Consulting Staff, Department of Emergency Medicine, Mount Sinai Hospital

Jessica Freedman, MD is a member of the following medical societies: Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Vaishali Patel, MD Assistant Clinical Professor, Co-director of Quality Assurance/Continuing Quality Improvement, Department of Emergency Medicine, Mount Sinai School of Medicine; Consulting Staff, Department of Emergency Medicine, Mount Sinai Medical Center; Director of ED PAs, Department of Emergency Medicine, Mount Sinai Medical Center

Disclosure: Nothing to disclose.

Suzanne Bentley, MD Assistant Professor, Departments of Emergency Medicine and Medical Education, Elmhurst Hospital, Mount Sinai School of Medicine

Suzanne Bentley, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Medical Womens Association, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Acknowledgements

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. Roberts JR, Hedges JR, Chanmugam AS, et al. Splinting techniques. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: Saunders; 2004. chap 51.

  2. Cuomo AV, Howard A, Hsueh S, Boutis K. Gartland type I supracondylar humerus fractures in children: is splint immobilization enough?. Pediatr Emerg Care. 2012 Nov. 28 (11):1150-3. [Medline].

  3. Moraleda L, Valencia M, Barco R, González-Moran G. Natural history of unreduced Gartland type-II supracondylar fractures of the humerus in children: a two to thirteen-year follow-up study. J Bone Joint Surg Am. 2013 Jan 2. 95 (1):28-34. [Medline].

  4. Naik AA, Xie C, Zuscik MJ, Kingsley P, Schwarz EM, Awad H, et al. Reduced COX-2 Expression in Aged Mice is Associated with Impaired Fracture Healing. J Bone Miner Res. 2008 Oct 10. [Medline].

  5. Matsumoto MA, De Oliveira A, Ribeiro Junior PD, Nary Filho H, Ribeiro DA. Short-term administration of non-selective and selective COX-2 NSAIDs do not interfere with bone repair in rats. J Mol Histol. 2008 Aug. 39(4):381-7. [Medline].

  6. Vuolteenaho K, Moilanen T, Moilanen E. Non-steroidal anti-inflammatory drugs, cyclooxygenase-2 and the bone healing process. Basic Clin Pharmacol Toxicol. 2008 Jan. 102(1):10-4. [Medline].

  7. Reichman E, Simon RR, eds. Emergency Medicine Procedures. New York: McGraw-Hill; 2004. chap 68-9, 75-6.

  8. Tintinalli JE, Kelen GD, Stapczynski JS, et al. Injuries to the elbow and forearm. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw Hill; 2004. chap 270.

  9. Halanski MA, Halanski AD, Oza A, Vanderby R, Munoz A, Noonan KJ. Thermal injury with contemporary cast-application techniques and methods to circumvent morbidity. J Bone Joint Surg Am. 2007 Nov. 89(11):2369-77. [Medline].

  10. Halanski M, Noonan KJ. Cast and splint immobilization: complications. J Am Acad Orthop Surg. 2008 Jan. 16(1):30-40. [Medline].

 
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Measuring and placing sleeve.
Applying cast padding.
Measuring plaster.
Preparing and applying splint.
 
 
 
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