Medication Summary
The goals of pharmacotherapy are to treat pain and reduce morbidity. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) and narcotic analgesics can be administered to palliate ischemic pain.
Nonsteroidal Anti-Inflammatory Drugs
Class Summary
NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase (COX) activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Naproxen (Naprosyn, Aleve, Naprelan, Anaprox)
Naproxen is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing COX activity, which results in decreased prostaglandin synthesis.
Ibuprofen (Motrin, Advil, Addaprin, Caldolor)
Ibuprofen is the drug of choice (DOC) for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Indomethacin (Indocin)
Indomethacin 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 XR, Cataflam, Zipsor, Cambia, Zipsor, Zorvolex)
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.
Analgesics
Class Summary
Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained trauma.
Acetaminophen (Tylenol, FeverAll, Aspirin Free Anacin)
Acetaminophen is the DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, who have upper GI disease, or who are taking oral anticoagulants.
Acetaminophen and codeine (Tylenol #2, Tylenol #3, Tylenol #4)
This combination is indicated for the treatment of mild to moderate pain. The available dosage strengths are as follows:
•Tylenol #2: 300 mg Tylenol/15 mg codeine
•Tylenol #3: 300 mg Tylenol/30 mg codeine
•Tylenol #4: 300 mg Tylenol/60 mg codeine
Hydrocodone and acetaminophen (Vicodin, Lorcet, Lortab, Norco)
This drug combination indicated for moderate to severe pain.
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Feet of patient with thromboangiitis obliterans (Buerger disease). Note ischemic ulcers on distal portion of left great, second, and fifth toes. Although patient's right foot is normal in gross appearance, angiography demonstrated compromised arterial flow to both feet.
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Superficial thrombophlebitis of great toe in patient with thromboangiitis obliterans (Buerger disease).
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Tobacco smoke stains on male patient's fingers suggest diagnosis of thromboangiitis obliterans (Buerger disease). Patient presented with small, painful ulcers on tips of thumb and ring finger.
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Lower-extremity arteriogram of peroneal and tibial arteries of patient with thromboangiitis obliterans (Buerger disease) demonstrates classic findings of multiple small and medium-sized arterial occlusions with formation of compensatory "corkscrew collaterals."
Tables
Positive Criterion |
Positive Points |
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Age at onset |
< 30 y (+2) 30-40 y (+1) |
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Foot intermittent claudication |
Present (+2) By history only (+1) |
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Upper extremity |
Symptomatic (+2) Asymptomatic (+1) |
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Migrating superficial thrombophlebitis |
Present (+2) By history only (+1) |
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Raynaud phenomenon |
Present (+2) By history only (+1) |
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Angiography; biopsy |
If typical, both (+2) Either(+1) |
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Negative Criterion |
Negative Points |
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Age at onset |
45-50 y (−1) >50 y (−2) |
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Sex; smoking |
Female (−1) Nonsmoker (−2) |
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Location |
Single limb (−1) No lower extremity involved (−2) |
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Absent pulses |
Brachial (−1) Femoral (−2) |
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Arteriosclerosis, diabetes, hypertension, hyperlipidemia |
Discovered 5.1-10 y after diagnosis (−1) Discovered 2.1-5 y later (−2) |
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Score |
Probability of Diagnosis |
0-1 |
Diagnosis excluded |
2-3 |
Diagnosis suspected (low probability) |
4-5 |
Diagnosis probable (medium probability) |
≥6 |
Diagnosis definite (high probability) |
