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Anaesthesiology > Analgesia > Flashcards

Analgesia Flashcards

1
Q

What is porphyria variegate?

A

Genetic disorder. Deficiency in any enzyme in haem biosynthetic pathway. Accumulation of haem intermediaries.

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2
Q

How confirm porphyria variegate diagnosis?

A

Test urine Ala and PBG

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3
Q

Name 3 triggers porphyria variegate

A

• Drugs: barbiturates!, diazepam, ketorolac, phenytoin, birth control pills, sulfonamides
• stress (give midazolam premed)
• hypoglycaemia
• sunlight
Dehydration (fluid load 10% dextrose with electrolytes)

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4
Q

Treatment porphyria variegate attack? (4)

A

• Stop precipitating drug
• hydrate with 10% dextrose-saline infusion
• treat symptoms: pain, seizure (midazolam), ht, tachy
• haem arginate official treatment

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5
Q

Which agents are definitely safe in porphyria variegate? (9)

A

• Succinylcholine
• Atropine
• neostigmine
• pancuronium
• nitrous oxide
• procaine
• meperidine (pethidine)
• fentanyl
• morphine

Regional anaesthesia, ketamine, etomidate controversial.
Thiopentone absolute contraindication!!

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6
Q

Which analgesic targets secondary hyperalgesia with andromic release of substance p?

A

Capsaicin

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7
Q

Which 3 analgesics target NMDA receptors?

A

• Ketamine
• magnesium.
Dextromethorphan
Nitrous oxide
Xenon

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8
Q

Which 2 analgesics target GABA receptors?

A

• Pregabalin
• gabapentin

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9
Q

Which 2 analgesics target descending alpha 2 pathway?

A

• Clonidine
• Dexmedetomidine

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10
Q

Name an opioid receptor antagonist

A

Naloxone

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11
Q

Which opioids target mu receptor in brain, brainstem and spinal cord and what effects do they have? (5)

A

Analgesia, euphoria, respiratory depression, constipation
•Morphine
• fentanyl
• met-enkephalin
. B-endorphin

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12
Q

Which opioids target kappa receptor in brain, brainstem, hypothalamus and spinal cord and what effects do they have? (3)

A

Spinal analgesia, sedation, dysphoria
• morphine
• oxycodone

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13
Q

Which opioids target delta receptor in telencephalon and spinal cord and what effects do they have? (3)

A

Analgesia, antidepressant, dependence
-leu-enkephalin
-B-endorphin

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14
Q

When should opioid be prescribed?

A

Only for severe pain because most potent analgesics

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15
Q

Name 3 long acting opioids

A

-morphine (longest)
-tramadol
-pethidine

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16
Q

Name 2 medium acting opioids

A

Fentanyl
Sufentanyl
Take 3-5 minutes, work for 30-60 minutes

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17
Q

Name a short acting opioids

A

Alfentanil
1 minute onset, very potent, last about 10 minutes

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18
Q

Name an ultra short acting opioids

A

Remifentanil. 3 minutes and fastest onset of 2 min

19
Q

Name 6 side effects cox2 inhibitors and NSAIDs

A

-renal impair
-gastric ulceration
-inhibit platelet aggregation (thrombosis)
-bronchoconstriction
-fluid retention
-PDA closure fetus
COX2 specific increase risk MI

20
Q

Name 4 NSAIDs that have Full COX 1 and 2 inhibition

A

Full COX 1 and 2 inhibition
-aspirin (irreversible)
-ibuprofen
-diclofenac
-naproxen
-indomethacin

21
Q

Name 3 NSAIDs with preferential COX2 and partial 1inhibition

A

Nimesulide
Meloxicam
Etodolac

22
Q

Name 3 NSAIDs with primary COX2 and minimal 1inhibition

A

Etoricoxib
Celecoxib (sulfonamide)
Rofecoxib

23
Q

Name 3 NSAIDs with weak COX2 and 1inhibition

A

Paracetamol
5-ASA (mesalazine)
sulfasalazine

24
Q

Similarity between mivacurium and cocaine.

A

Both metabolised by buteryl cholinesterase

25
Q

Analgesic agent of choice for trauma patients with gross hypovolaemia?

A

Opioids and paracetamol
NSAIDs contraindicated!

26
Q

Which 2 receptors does morphine target?

A

Mu and kappa opioid receptors

27
Q

Which analgesic agent is deleterious for the shocked hypovolaemic patient?

A

Ketorolac (NSAID)

28
Q

Describe the WHO pain ladder.

A

Multimodal step-up approach!
1. Non opioid: paracetamol
2. NSAID
3. Weak opioid: tramadol codeine
4. Strong opioid morphine

Can give adjuncts with these eg ketamine, dexmedetomidine, regional,steroids (gabapentin- chronic pain)

29
Q

Which analgesic is good to give with TIVA infusion?

A

Remifentanil
• ultra short acting
• doesn’t build up in body: organ independent breakdown

30
Q

Which analgesic agents are good for short airway procedures eg bronchoscope?

A

Alfentanyl
• good intubation response, very potent
• short acting, last about 10 minutes

31
Q

Which analgesic is best to use for induction and intra-op acute pain?

A

Fentanyl and sufentanyl

32
Q

Give example of multimodal analgesia in a patient undergoing hysterectomy

A

• Fentanyl: preop and intra-op boluses
. Regional: tap
• paracetamol
• morphine o, 1 mg/kg every 4 hours towards end surgery and post-op (patient controlled best, give 1 mg every 5-6 minutes)
• NSAIDs post op if candidate

33
Q

Dose fentanyl?

A

1 ug/kg (0,001 mg)

34
Q

Dose sufentanyl?

A

0,1 ug/kg (0,0001 mg)

35
Q

Analgesic opioid of choice in asthmatics?

A

Pethidine (meperidine)
Synthetic opioid so less bronchospasm

36
Q

Side effect tramadol?

A

Very pro-emetic

37
Q

Name 5 side effects naloxone

A

• tachycardia
• hypertension
• myocardial ischaemia
• cardiac failure
• pulmonary oedema

38
Q

Name 3 side effects flumazenil

A

Arrhythmia, ht, convulsions

39
Q

Atropine class/moa? NB

A

Antmuscarinic. Antagonise ach and work on exocrine glands to decrease secretions, smooth muscle (bronchoditation), cardiac (tachy), CNS

40
Q

Cox 1 vs cox 2? (2)

A

• Cox 1 generates prostaglandins involved in protection gi mucosa vs prostaglandins that mediate inflammation and pain all over body
• Inhibitors more gastric side effects and bleeding risk vs less

41
Q

Name 8 side effects morphine

A

Morphine
Myosis
Out of it (sedation)
Respiratory depression
Pneumonia (aspiration)
Hypotension
Infrequency (constipation, urinary retention )
Nausea
emesis

42
Q

Which fibres are responsible for the transmission noxious stimuli? (2)

A

= elicit tissue damage and activate nociceptors. AKA pain.
• C fibres !
• A delta fibres

43
Q

Flumazenil class?

A

Selective GABA A receptor antagonist
(Antag Benzo)

Anaesthesiology (24 decks)

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