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Prescribing > Acute pain management > Flashcards

Acute pain management Flashcards

1
Q

At what dose does the risk of harm increase significantly (morphine )

A

120mg a day

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2
Q

Is morphine appropriate for long term chronic pain therapy

A

There is a lack of robust evidence to support opioid’s in long term treatment of pain

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3
Q

What are the 3 main receptors that opioids work on

A

Mu - most clinically relevant
Delta
Kappa

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4
Q

Which demographics are at most risk with Opioid therapy

A

Respiratory disease such as sleep apnoea
Hepatic/ renal dysfunction
Older adults
People who are at risk of developing problematic Opioid use and patient who have Co morbid mental health conditions

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5
Q

Morphine has low lipid solubility can it penetrate the blood brain barrier?

A

Yes, but slowly. So onset is slower than fentanyl, which has high lipid solubility and rapid onset

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6
Q

In G.P. practise how many patient prescribed Morphine for chronic pain feel they benefit from it

A

1 in 10

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7
Q

When was the last guidance on chronic pain published by NICE

A

April 2021

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8
Q

What are the two classes of Non Cancer Chronic pain

A

Primary: No underlying condition appear out of proportion to observable injury
Secondary: is secondary to underlying condition (E.G. Arthritis)

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9
Q

Chronic pain is divided in to two categories’

A

Cancer and Non cancer

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10
Q

Pain signals move through afferant and efferent pathways what is the difference?

A

Afferant is incoming towards the dorsal horn and the Efferent is away

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11
Q

What are the 3 types of modulation of pain

A

Segmental inhibition
Endogenous (Opioid system)
Descending inhibitory system

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12
Q

how many steps on th WHO analgesic ladder

A
  1. Non opioid i/c adjuvants
    Mild opioid i/c Adjuvants
    Strong opioid i/c adjuvants
    A potential 4 step is considered nerve blocks such as epidurals
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13
Q

What are the 4 A’s of effective analgesia

A

Analgesic
Activities of daily living
Adverse effects
Aberrant drug taking behaviours

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14
Q

In the new Nice guidelines 2021

what are the two sub categories’ in The Active section of Non Pharmacological management of pain

A

Active Behaviours: Corrective posture or exercise
Active Cognitive:
Relaxation or meditation

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15
Q

In the new Nice guidelines 2021

what are the two sub categories’ in The Passive section of Non Pharmacological management of pain

A

Passive Behaviours: Hot baths and diets

Conventional: medication acupuncture

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16
Q

What are the 3 classes of analgesia

A

Non opioids such as NSAIDs & paracetamol
Adjuvants such as Anticonvulsants’ & antidepressants
And opioids both weak codeine and Dihydrocodeine or Strong such as morphine and fentanyl

17
Q

What are the two types of NSAIDS

A

Selective: Blocking COX 2 only

Non selective Blocking Blocking both COX 1 and COX 2 pathways

18
Q

How do NSAIDs work

A

After injury Aracadonic acid is produced which interacts with exisiting COX 1 Producing COX2 producing histamines, inflammation and pain. Non selective NSAIDs interfere with the reaction with COX 1 and selective interfere with the reaction with COX 2

19
Q

What is a rule of thumb for prescribing opioids for break through pain

A

A patient with no renal or hepatic co morbidities should be prescribed 20- 30mg oral morphine a day it should be titrated until a balance of side effects and pain control is achieved and break through pain relief should be no more than one tenth to one sixth of the total daily dose

20
Q

What are the 4 perils of opioids

A

Tolerance
Physical dependence
Addiction
Opioid withdrawal

21
Q

What is the difference between physical dependence and addiction

A

Physical Dependance is Neuro pharmacological as a result of Neuro adaptation and neuro plasticity Addiction is Neuro pharmacological and behavioural influenced by genetic psychosocial and environmental factors

22
Q

How do you move from one opioid to another if the patient has built up a tolerance

A

Use the equitable tables in the BNF the standard unit is a 10mg dose of morphine

23
Q

How do anti depressants work as analgesia

A

They are prescribed generally at a tenth of the antidepressant dose but they inhibit neuro transmission of pain (To be used with caution in the Elderly)

24
Q

How do anticonvulsants work

A

They can enhance the effect of analgesia co administered. Specifically gabapentiods stabilise the neuro membrane which inhibits neuro transmission of pain, which can give rise to Euphoric effects (reclassified in 2018)

25
Q

In the 2012 NICE Guide lines for neuropathic pain What 4 medications are offered

A

Try amitriptyline Duloxetine Gabapentin or pregabalin if one doesnt work offer one of the other 3 Tramadol should only be used for rescue and Capsaicin for localised pain or if the patient cant take oral medication

Prescribing (18 decks)

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