Analgesia

Question 1

What would you use for mild acute pain management?

Answer 1

Non-pharmacological =rest, reassurance, ice pack, heat pack

If not relieved by non-pharmacological= paracetamol 1g 4-6hr up tp 4g a day

Question 2

What would you use for moderate acute pain management?

Answer 2

NSAIDS

1. Ibuprofen 200-400mg PO tds OR
2. diclofenac 25-50mg PO bd or tds
3. naproxen 250-500mg PO bd

use minimum dose for the shortest period, usually not exceeding 2 weeks, review in 2 weeks

Question 3

When is NSAID use counter-indicated?

Answer 3

low eGFR <30 ml/min

active peptic ulcer disease

Question 4

In what conditions is it acceptable to just use a lower dose NSAID?

Answer 4

kidney disease
history of peptic ulcer disease
HTN
heart failure

Question 5

What are adverse effects of NSAIDS?

Answer 5

Cardiovascular: rise in BP, fluid retention, MI, stroke

Gastro: gastric erosions, peptic ulcers, oesophageal ulceration, GI bleeding, perforation, upper abdominal pain

Renal: renal impairment

Question 6

What are selective COX 2 inhibitor NSAIDS?

Answer 6

Celecoxib (celebrex)

would reduce risk of ulcer disease

Question 7

When do you add an oral opioid ? (etg)

Answer 7

Patient has moderate pain not adequately managed with NSAID or paracetamol

If pain interfering with patient’s quality of life

Question 8

What would you use in management of acute moderate pain with oral opioid?

Answer 8

1. Codeine: 30-60mg PO 6 hourly as necessary OR
2. Tramadol: immediate release 50-100mg PO up to qid OR
3. Oxycodone immediate release 2.5-15mg PO 4 hourly as necessary (titrate response)

Question 9

When prescribing opioids when do you review patient?

Answer 9

review in 48hrs if pain has not resolved

Question 10

Adverse effects of short term use of opioids

Answer 10

Resp: respiratory depression
Cardio: bradycardia, hypotension, postural hypotension
Neuro: dose dependent confusion, delirium, dysphoria, euphoria, cough suppression, impaired cognition (warning about driving)
Derm: sweating, flushing, urticaria, pruritis
GIT: nausea, vomiting, anorexia, constipation
Urinary: urinary retention, difficulty with mictruition