Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Chapter 4 - Nervous System > 6. Pain > Flashcards

6. Pain Flashcards

1
Q

Different types of pain

A

Nociceptive - tissue damage

Neuropathic -Nerve damage (burning, prickling, stabbing sensation)

Nociceptive - sensitisation changes in pain pathway

Further split into
primary (no cause) vs secondary pain (related to an underlying condition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pain treatment

A

WHO analgesic ladder

For mild pain
Step 1: Non-opioid (paracetamol, NSAIDs)

For mild-moderate pain
Step 2: Weak opioid (codeine, dihydrocodeine, tramadaol)

For moderate-severe pain:
Step 3: Strong opiod: (morphine, fentanyl patches)

+/- Adjuvants:
Tricyclic antidepressants: Amitryptiline, Nortryptiline
Antiepiletics: Gabapentin, Pregablin
Nerve compression: dexamethasone
Bone metastases: Bisphosphonates
Muscle spasm: Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of analgesics

A

Non-opioid:
Aspirin
Nefopam
NSAID
Paracetamol

Weak opiod:
Codeine (CD5, CD2-injection)
Dihydrocodeine (CD5)
Meptazinol (POM)
Tramadol (CD3)

Strong opioid:
Buprenorphine (CD3)
Diamorphine
Fentanyl (CD2)
Hydromorphone (CD2)
Morphine (CD2, CD5<13mg/5ml)
Oxycodone (CD2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Paracetamol dose and counselling

A

0.5-1g every 4-6 hours PRN (max 4g per day)

Label: Do not take more than 2 at any time. Do not take more than 8 in 24 hours.

Label: Contains paracetamol. Do not take anything else containing paracetamol while taking this medicine. Talk to a docotr at once if you take too much of this mdicine even if you feel unwell.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Paracetamol overdose

A

This applies to tablets, soluble tablets, capsules

Overdose: Liver damage (higher risk <50kg)

Treated with Acetylcysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Aspirin dose

A

300-900mg every 4-6 hours (max 4g per day)

Label: Do not take anything else containing aspirin while taking this medicine

Label: Take with or just after food or meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Aspirin side effects

A

GI-irritation
Enteric formulations can prevent this by bypassing the stomach and dissolving in the small intenstine.

Tinnitus
At higher doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Aspirin contraindications

A

Contraindicated in individuals under 16
Aspirin is a salicylate - so cannot be used in children under 16 years, due to risk of Reye’s syndrome.

Exceptions: kawasaki disease, or as an antiplatelet

Contraindicated in people with NSAID hypersensitivity
e.g bronchospasm, asthma attack, rhinitis, urticaria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Opioid mechanism of action

A

Opioids act on the opioid μ receptors in the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Opioid side effects

A

Tolerance - higher doses needed to achieve the same analgesia.
Patients must be warned of signs of tolerance: respiratory depression, pinpoint pupils, coma

Physical dependence - Appears on abrupt withdrawal

Psychological dependence -compulsive and continued use despite harm.
If addiction and dependence occurs: agree treatment strategy, withdrawal pain and monitor regularly

Must be used in caution in substance use, mental health disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Opiods side effects

A
  • Respiratory depression - make breathing slow and shallow

Increased risk of this with benzodiazepines

Antidote: Naloxone (however only partially reverses effects for buprenorphine)

  • Nausea and vomiting - as opioids work on the CTZ.
    Antiemetic metoclopramide is useful
  • Constipation
    Osmotic + stimulant laxative
  • Sedation
    Should avoid driving and alcohol (also CNS depressant)
  • Hallucinations and Euphoria
  • Pupil constriction
    Contra-indicated in heady injury or neurological assesments
  • Dry mouth
  • Hypotension
  • Hyperalgesia is a long term effect
    Treated by reducing dose or switching treatment, initiated by specialist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Opioid side effects

A

M - miosis (pinpoint pupils), muscle rigidity
O - out of it (sedation)
R- respiratory depression
P - postural hypotension
H - hyperalgesia hallucinations
I - Infrequency
N - Nausea and vomiting
E - Euphoria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Opioid interactions

A

Interacts with other CNS depressants, as there is an increased risk of CNS depression, i.e sedation

Alcohol, benzodiazepines, Z-drugs, antihistamines (sedating), antipsychotic, barbiturates, irreversible MAOIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Codeine and dihydrocodeine are weak opioids. What route should it never by given by?

A

Can never be given intravenously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Codeine for coughs and colds, contraindications

A

Should never be used by a breastfeeding mum

Should not be used by a child under 12 years as it is associated with respiratory side effects

Should not be used by people who are ultra-rapid metabolisers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If codeine is being used in children for analgesia, what is the dose?

A

12+ years: For 3 days only, max 240mg daily every 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tramadol side effects

A

Also acts on the serotonergic, noradrenergic pathways, unlike other opioids, therefore responsible for:

  • Psychiatric reactions
  • Reduced seuzire thresholds
18
Q

Tramadol interactions

A

Tramadol is a serotonergic drug. It interacts with serotonergic drugs to increase the risk of serotonin syndrome

Antidepressants (TCA, SSRI, MAOI), Amfetamines, Lithium, MAO-B e.g selegiline, methadone, St John’s wort, 5-HT1 agonists, e.g sumatriptan, 5-HT3 receptor antagonist e.g ondansetron

19
Q

Morphine dose and route

A

Oral morphine: Taken every 4 hours
Patients may also be put on a modified release preparation taken every 12 or 24 hours

Route: 1/2 the oral dose

Morphine also used in dyspnoea in palliative care, as it slows breathing, making it easier to breathe

20
Q

Diamorphine dose

A

Dose: 1/2 the oral morphine dose

Route: Preferred in palliative care

21
Q

Morphine side effects

A
  • Nausea and vomting
  • Euphoria
22
Q

Diamorphine vs morphine

A

More soluble than morphine. Better choice in palliative care to avoid fluid overload.
Also causes less nausea than morphine

23
Q

Diamorphine side effects

A
  • Hypotension
  • Nausea
24
Q

Breakthrough pain

A

Sudden pain that breaks through between regular doses of pain medication.
If this occurs rescue doses are offered, as an immediate release medication.

Rescue doses: 1/10th -1/6th of the total daily dose, given every 2-4 hours as required.

Immediate-release preparation examples:
Oral morphine, oxycodone

25
Q

Buprenorphine and fentanyl

A

Unsuitable in mild pain and in rapidly changing pain levels as they have a long action and cannot be rapidly titrated to match pain levels

26
Q

Buprenorphine side effect

A
  • Withdrawal

Nalaxone partially reverses burpenorphine. Which means pain is not completely masked

27
Q

Buprenorphine dose

A

Can be given as 72hour patches, 4 day patches and 7 day patches.

28
Q

Fentanyl patch duration

A

72 hour patches

29
Q

Fentanyl side effects

A
  • Respiratory depression

Should not be used in opioid naive patients

Must safely dispose patches, to prevent accidental exposure in children

Signs of opioid toxicity:
respiratory depression, pinpoint pupils
Must remove patch if experiencing breathing difficulties or impaired speech

30
Q

Transdermal patch application

A
  • Should be applied to dry, non-irritated, non-hairy skin on the upper arm or torso
  • Rotate patch site to prevent the skin form becoming itchy or sore
  • Avoid hot baths and saunas
31
Q

What is a migraine

A

A moderate-severe headache that is unilateral and pulsating.

It is episodic: <15 days/month
Or
Chronic: ≥ 15 days/month

32
Q

Migraine symptoms

A
  • Throbbing pain on one side
  • Nausea and vomiting due to reduced gastric motility and emptying
  • Sensiitvity to light

Aura (warning lights)

Visual - flickering lights, zizags
Dysphasia - impaired ability to use or understand words
Sensory: numbness, tingling
Dizziness, Off-balance

33
Q

Migraine and combined oral contraceptives

A

If you have migraine with aura, you should not take the combined oral contraceptive pill. This is because the combined pill is associated with a very small increased risk of stroke. This risk increases when the pill is taken by women who have migraine with aura.

Much preferred to take progestogen only contraceptives

34
Q

Drugs used to treat migraine attacks

A

5-HT1 Receptor agonist
* Almotriptan
* Sumatriptan
* Rizatriptan

Anti-emetics
* Domperidone
* Metoclopramide
* Prochlorperazine

Oral analgesics
* Paracetamol
* Aspirin
* Ibuprofen
* Diclofenac

35
Q

Acute migraine attack treatment

A

1st line: Aspirin/ibuprofen OR 5-HT1 receptor agonist (sumatriptan)

2nd line: Sumatriptan AND Naproxen

If nausea/vomiting is present: metoclopramide or domperidone as they promote gastric motility and emptying (prokinetic antiemetics). This improves absorption of analgesics.

Overuse medication may cause tolerance.
Treatment should be limited to max 2 days a week

36
Q

Migraine prevention

A

1st line: Propanolol
If unsuitable, offer another beta blocker: atenolol, bisoprolol, metoprolol, nadolol, timolol

If unsuitable: topiramate

37
Q

5-HT1 receptor agonist “triptans” mechanism of action

A

Prevent the release of neuropeptides which are involved in the pain pathway

Act on 5-HT1B/1D receptors and cause vasoconstriction of the cranial blood vessels

38
Q

5-HT1 receptor agonist “triptans” dose

A

Used in acute migraine

One dose should be taken ASAP after onset. A second dose should be taken 2 hours later.

If the drug is naratriptan, the second dose should be taken 4 hours later.

A second dose should not be taken for the same attack.

39
Q

5-HT1 receptor agonist “triptans” side effects

A

As triptans work by constricting cranial blood vessels, their action also extends to constricting other blood vessels: coronary arteries.

Patients must stop if they experience: heat, tightness in the chest or throat

Can cause high blood pressure and ischaemia due to reduced blood oxygen supply.

Therefore contra-indicated in cardiovascular conditions:
angina, myocardial infarction, stroke, transient ischaemic stroke, moderate-severe uncontrolled hypertension.

40
Q

5-HT1 receptor agonist “triptans” interactions

A

5-HT1 agonists is a serotonergic drug. It interacts with serotonergic drugs to increase the risk of serotonin syndrome
​
Antidepressants (TCA, SSRI, MAOI), Amfetamines, Lithium, MAO-B e.g selegiline, methadone, St John’s wort, 5-HT1 agonists, e.g sumatriptan, 5-HT3 receptor antagonist e.g ondansetron

41
Q

Cluster headaches

A

Sharp, peircing pain around the eye.

Usually happens at the same time of day or year.

Headaches last between 15 minutes to 3 hours

42
Q

Cluster headache treatment

A

Cluster headaches rarely respond to standard analgesics

Sumatriptan is given by subcutaneous injection.
Sumatriptan nasal spray or zolmitriptan nasal spray can be used if injection is unsuitable.

Chapter 4 - Nervous System (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions