Anaesthetics and ICU Flashcards
Name an anti-muscarinic used to treat pain associated with smooth muscle spasm.
Hyoscine butylbromide - also known as Buscapan - is used to give symptomatic relief of pain associated with GI or GU smooth muscle spasm.
What is mebeverine?
It is a simple anti-spasmodic selective to smooth muscle of GI (particularly colon) but has no anti-muscarinic action.
What is mebevirine used for?
IBS primarily
Name a counter irritant used topically for postherpetic neuralgia and painful diabetic neuropathy.
Capsaicin acts by counter irritation. It is common on starting treatment to experience a transient burning sensation/pain.
What is post-herpetic neuralgia?
It is a complication of shingles (herpes zoster virus) and results in burning pain long after the shingles rash/chicken pox has disappeared.
What opioid is available as lozenges and as transdermal patches?
Fentanyl. Lozenges are used for breakthrough pain in patients on morphine and patches are used for tx of chronic pain.
Name an anti-histamine and 5HT-antagonist used in the prophylaxis of migraine.
Pizotifen
What are Sumaptriptain and ergotamine used to treat acutely?
Acute migraine attacks
What drugs are effective in treating renal colic?
- Diclofenac (NSAID)
- Hyoscine butylbromide (spasmolytic)
How do you treat post-herpetic neuralgia?
- Capsaicin
2. TCA (amitriptyline is used to treat PHN but treatment can be unsatisfactory)
What is the first line for migraine prophylaxis?
Topiramate or propranolol
What is the Tx of acute migraine?
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
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?
Triptains (sumatriptan) are the recommended tx of choice for px with migraine unresponsive to simple analgesics
Px with IBS complaining of colicky abdominal pain not responding to simple analgesics
Mebeverine
What is the first line tx for pain control in px going through labour?
Entonox (nitrous oxide + oxygen).
What are some side effects of Entonox?
Hyperventilation and light-headedness
What is the most effective diagnostic/confirmatory investigation for subarachnoid haemorrhage?
CT will confirm 95% of SAH.
If px has SAH, what will a lumbar puncture show?
Blood will be present (xanthochromia - yellow-ish pigment due to break down of bilirubin)
What drug should be started IV for acute glaucoma?
IV acetazolamide
What is the drug of choice for trigeminal neuralgia?
Carbamazapine
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.
Acute glaucoma
What is carbamazepine?
Drug used primarily to treat neuropathic pain and epilepsy.
What can trigger trigeminal neuralgia pain?
Washing the affected area, shaving, eating, talking and dental processes
What is temporal arteritis?
Chronic inflammation of the large and medium arteries of the head.
How may temporal arteritis present?
- severe pain on combing hair
- visual loss (blurred vision, sudden blindness, diplopia)
- headache
- fever
- bruits
- tinnitus
How do you manage giant cell/temporal arteritis?
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
What drug is used in the prophylaxis of migraine?
Propanolol
