Pain Pathophysiology Overview

Receptors involved in pain modulation: opioid receptors alpha-2 adrenergic receptors voltage-gated calcium channels NMDA receptors Chemical mediators (sensitize neurons to pain): substance P prostaglandins bradykinin glutamate Neurotransmitters (facilitate pain modulation): norepinephrine serotonin GABA

Overview of Types of Pain

acute pain: < 1 month in duration chronic pain:  > 6 months in duration can arise from nociceptive and/or neuropathic origins Nociceptive pain:  experienced in the presence of an injury or trauma.  Can be described as sharp, dull, or achy and may either be localized or diffuse. examples include: osteoarthritis and pancreatitis. Neuropathic pain: pain … Continue reading

Risk Factors for Statin-Induced Myopathy

High statin doses People whom are frail or have a small frame Elderly Perioperative periods Untreated hypothyroidism Diabetes Renal Diseases Liver Diseases Medications:  Nicotinic Acid, Fibrates (especially gemfibrozil), CYP450 3A4 Inhibitors (for simvastatin, lovastatin, and atorvastatin)

Lifestyle Recommendations for Patients with Hyperlipidemia

Saturated fat should account for less than 7% of total calories Total fat should account for less than 25-35% of total calories Fiber:  20-30 grams daily Consume less than 200 mg of dietary cholesterol daily

Lipid Management Goals

Non-LDL Cholesterol Triglycerides < 150 mg/dL Total Cholesterol < 200 mg/dL HDL > 40 mg/dL (males) HDL > 50 mg/dL (females) Non HDL Cholesterol:  LDL goal + 30 mg/dL LDL Cholesterol LDL < 70 mg/dL:  Preexisting coronary heart disease (CHD) at high risk LDL < 100 mg/dL:   CHD (myocardial infarction, unstable or chronic stable … Continue reading

Secondary Causes of Dyslipidemia

The following can increase Low Density Lipid (LDL) cholesterol levels: Hypothyroidism Obstructive Liver Disease Nephrotic Syndrome Medications:  Progestin, Corticosteroids, Anabolic Steroids, Cyclosporine The following can increase Triglyceride (TG) levels: Diabetes Hypothyroidism Nephrotic Syndrome Chronic Renal Failure Obesity Medications:  Estrogen, Thiazide Diuretics, Beta Blockers, Corticosteroids, Atypical Antipsychotics The following can decrease High Density Lipid (HDL) cholesterol … Continue reading

Useful Websites Regarding Lipid Management National Cholesterol Education program provides national guidelines for nonpharmacologic and pharmacologic recommendations for lipid management. Clinical advisory from the American College of Cardiology, AHA and the National Heart, Lung and Blood Institute (NHLBI) on the prevention and management of statin-adverse events NHLBI designed website with supportive patient education materials AHA website … Continue reading