Anaesthetics and ICU

Question 1

Name an anti-muscarinic used to treat pain associated with smooth muscle spasm.

Answer 1

Hyoscine butylbromide - also known as Buscapan - is used to give symptomatic relief of pain associated with GI or GU smooth muscle spasm.

Question 2

What is mebeverine?

Answer 2

It is a simple anti-spasmodic selective to smooth muscle of GI (particularly colon) but has no anti-muscarinic action.

Question 3

What is mebevirine used for?

Answer 3

IBS primarily

Question 4

Name a counter irritant used topically for postherpetic neuralgia and painful diabetic neuropathy.

Answer 4

Capsaicin acts by counter irritation. It is common on starting treatment to experience a transient burning sensation/pain.

Question 5

What is post-herpetic neuralgia?

Answer 5

It is a complication of shingles (herpes zoster virus) and results in burning pain long after the shingles rash/chicken pox has disappeared.

Question 6

What opioid is available as lozenges and as transdermal patches?

Answer 6

Fentanyl. Lozenges are used for breakthrough pain in patients on morphine and patches are used for tx of chronic pain.

Question 7

Name an anti-histamine and 5HT-antagonist used in the prophylaxis of migraine.

Answer 7

Pizotifen

Question 8

What are Sumaptriptain and ergotamine used to treat acutely?

Answer 8

Acute migraine attacks

Question 9

What drugs are effective in treating renal colic?

Answer 9

• Diclofenac (NSAID)

- Hyoscine butylbromide (spasmolytic)

Question 10

How do you treat post-herpetic neuralgia?

Answer 10

1. Capsaicin

2. TCA (amitriptyline is used to treat PHN but treatment can be unsatisfactory)

Question 11

What is the first line for migraine prophylaxis?

Answer 11

Topiramate or propranolol

Question 12

What is the Tx of acute migraine?

Answer 12

Combination therapy of oral triptan & NSAID/paracetamol (sumatriptan). You can use NSAID or triptan or aspirin or paracetamol as monotherapy or consider adding an anti-emetic such as metoclopramide or domperidone

Question 13

Px already taking NSAIDs and low-dose co-codamol for recurring headaches worse towards end of day is getting little relief. What do you prescribe?

Answer 13

Triptains (sumatriptan) are the recommended tx of choice for px with migraine unresponsive to simple analgesics

Question 14

Px with IBS complaining of colicky abdominal pain not responding to simple analgesics

Answer 14

Mebeverine

Question 15

What is the first line tx for pain control in px going through labour?

Answer 15

Entonox (nitrous oxide + oxygen).

Question 16

What are some side effects of Entonox?

Answer 16

Hyperventilation and light-headedness

Question 17

What is the most effective diagnostic/confirmatory investigation for subarachnoid haemorrhage?

Answer 17

CT will confirm 95% of SAH.

Question 18

If px has SAH, what will a lumbar puncture show?

Answer 18

Blood will be present (xanthochromia - yellow-ish pigment due to break down of bilirubin)

Question 19

What drug should be started IV for acute glaucoma?

Answer 19

IV acetazolamide

Question 20

What is the drug of choice for trigeminal neuralgia?

Answer 20

Carbamazapine

Question 21

What is suspected if a px presents with constant and severe pain in one eye and forehead of one day duration. History is long-sighted for years but vision rapidly deteriorated in a few days. Examination shows red eye congested with dilated, non-responsive pupil.

Answer 21

Acute glaucoma

Question 22

What is carbamazepine?

Answer 22

Drug used primarily to treat neuropathic pain and epilepsy.

Question 23

What can trigger trigeminal neuralgia pain?

Answer 23

Washing the affected area, shaving, eating, talking and dental processes

Question 24

What is temporal arteritis?

Answer 24

Chronic inflammation of the large and medium arteries of the head.

Question 25

How may temporal arteritis present?

Answer 25

• severe pain on combing hair
• visual loss (blurred vision, sudden blindness, diplopia)
• headache
• fever
• bruits
• tinnitus

Question 26

How do you manage giant cell/temporal arteritis?

Answer 26

Prednisolone 60mg daily. Giant cell arteritis is associated with polymyalgia rheumatic (stiff and aching joints) and high dose prednisolone (40-60mg) should be started immediately

Question 27

What drug is used in the prophylaxis of migraine?

Answer 27

Propanolol