Analgesia

Question 1

Max dose paracetamol

Answer 1

4g QID young and fit 6g for 3-5/7

Question 2

3 non-selective NSAIDS

Answer 2

Naproxen ibuprofen indomethacin

Question 3

3 selective COX2 inhibitors

Answer 3

diclofenac celocoxib

Question 4

Benefits and risk of selective Cox 2

Answer 4

less GI ADR more CVS risk dt prothrombogenity

Question 5

route to achieve less NV for tramadol

Answer 5

subcut instead of IV

Question 6

benefits of tapentadol

Answer 6

less serotonin effects

Question 7

risks of tramadol

Answer 7

serotonin syndrome, lower seizure thredhold

Question 8

time to benefit of opioids IV Subcut/IM PR/PO

Answer 8

6min 30min 60min

Question 9

6 options for neuropathic pain

Answer 9

opioids tramadol ketamine TCAs SNRI Gabapentinoids

Question 10

5 actions of prostaglandin

Answer 10

1. mediates inflammation
2. pain
3. secretion of protective gastric mucus later
4. maintain renal perfusion
5. pt aggregation

Question 11

Mech of NSAIDs

Answer 11

Inhibits production of Pg from arachidionic acid

Question 12

SE of NSAIDS

Answer 12

1. bronchospasm
2. hyperventilation
3. GI ulceration
4. hep dysfunction (tranaminitis)
5. papillary necrosis and renal dysfunction
6. inhibition of pt aggregation
7. prolong bleed time
8. hyperglycaemia

Question 13

COX-1 Function

Answer 13

Housekeeping: gastric cytoprotection and platelet activation

Thus inhibitor impairs gastric cytoprotection and has antiplatelett

Question 14

COX-2 function

Answer 14

Proinflammatory

thus inhibitor is antiinflammatory/analgesic

Question 15

Cox 2 inhibitor 1 example 1 benefit and 1 risk

Answer 15

1. celocoxib
2. reduce risk of GI ulceration
3. Prothrombotic thus CVS risk

Question 16

NSAID contraindication, 10

Answer 16

1. PUD
2. IBD
3. renal failure GFR <30
4. cardiac failure
5. liver failure
6. postop
7. anticoagulated
8. aspirin sensitive asthma (20% of asthmatics)
9. rhinitis, urticarial
10. pregnant (3rd trimester), breastfeeding

Question 17

Why is COX2 prothrombotic

Answer 17

Inhibition of COX2 in BV => decrease in prostacyclin => increase in BP and increase pt aggr

Question 18

COX1 or 2 reduce renal blood flow and GFR

Answer 18

BOTH

Question 19

Amitriptyline Contraindications

Answer 19

1. prostatic hypertrophy - retention
2. closed angle glaucoma
3. hyperthyroidism - precuation, enhanced response
4. epilepsy - increase seizure frequency
5. CVS: 2nd and 3rd deg heart block
6. coronary disease - tachy -> angina
7. long QT syndrome, other meds that prolongs QT
8. orthostatic hypotension - exacerbation
9. psych - OD
10. serotonin toxicity
11. hepatic impairment - half dose
12. Elderly, pregnant, breastfeeding

Question 20

Nortriptyline benefits over amitriptyline

Answer 20

1. les s sedating
2. less likely to cause hypotension
3. less anticholinergic effects

Question 21

8-10% caucasian dont respond to codeine why

Answer 21

CYP2D6 non-metaboliser

none of codeine converted to morphine