Analgesia

Question 1

How do NSAIDs work?

Answer 1

• They block the COX1 or COX2 enzymes which suppress the production of prostaglandins.
• Prostaglandins are produced by injured tissues and cause inflammation, pain and fever. They can cause muscle contraction or dilation and clotting or prevent clotting.
• Baseline levels of prostaglandins are produced by COX1 and prostaglandins production in response to injury is caused by COX2.
• COX1 protects the stomach lining.

Question 2

Naproxen

Answer 2

NSAID non-selective Feminax

Question 3

Asprin

Answer 3

Prevents clotting as well as reducing pain and inflammation.

May cause gastric irritation

Enteric-coated preparations stop irritation but have a slow onset of action and are no good for single dose anagesia (unless overnight)

Question 4

Paracetemol

Answer 4

Analesia only, no NSAID activity

Question 5

What percentage of patients respond to any particular NSAID?

Answer 5

60%

Question 6

Ibuprofen

Answer 6

• Propionic acid derivative
• Less side-efects than other NSAIDs but weaker anti-inflammatory action than others

Question 7

Other propionic acid derivatives

Answer 7

• Naproxen
• Fenoprofen
• Flubirproffen
• Ketoprofen
• Dexketoprofen

Question 8

Nefopam HCL

(never, ever, feel oral pain again mum)

Answer 8

Has antimuscarinic side-effects

Stronger than ibuprofen and paracetemol

Question 9

Diclofenac sodium

Answer 9

• Voltarol
• As effecttive as naproxen

Question 10

Oxycodone

Answer 10

• Opinoid analgesic
• As effective as morphine
• Primarily used for pain in palliative care
• Oxycontin, Oxylan, reltebon, zomestine, abtard, carexil, leveraxo, lontec, onexila

Question 11

Morphine

Answer 11

• Opiod of choice for oral treatmennt of severe pain
• Confers a state of eupohoira and mental detachment
• Can cause nausea and vomiting.

Question 12

Fentanyl

Answer 12

• Opioid painkiller
• Used for intra-operative analgesia

Question 13

Tramadol HCL

Answer 13

Has two analgeisa mechanism:

• Opiod effect
• Serotonergic and adrenergic pathway

Has fewer of the typical opioid side-effects

Only partially reversed with naloxone.

Question 14

What sort of pain do opiates work on best?

Answer 14

Visceral pain better than somatic pain.

Question 15

Codeine

Answer 15

• Narcotic painkiller
• Small amount is converted to morphine
• Exact mechanism unknown
• Reduces feeling of pain but you’re still aware of it.

Question 16

Co-codamol

Answer 16

Paracetemol and codeine mix

Question 17

Dihydrocodeine

Answer 17

• Similar to codeine
• Slightly more analgesia than codeine but also more nausea
• Often combined with paracetemol in paramol

Question 18

Gabapentin

Answer 18

• Used to treat neuralgia e.g. shingles pain
• Migraine pain
• Hot flushes in menopausal women with history of cancer
• Seizures

Question 20

What three steps to treat migraines:

Answer 20

1. Simple analgesic although best to use a dispersive as perostalsis is reduced during an attack and these work better
2. NSAID, reduces inflammation that causes the headache
3. Triptan, 5HT1 receptor agonist, activate receptors that reduce swelling associated with mirgrain

Question 21

Triptans

Answer 21

(sumatriptan) Imigran
(naratriptan) Naramig
(zolmitriptan) Zomig
(forvatriptan) Migard