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Therapeutics > Analgesia > Flashcards

Analgesia Flashcards

1
Q

Pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

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2
Q

Types of pain

A
  • nociceptive - stimulation of nociceptors
  • neuropathic - pain signal generated by pathological processes in CNS or PNS
  • psychogenic - no apparent organic basis
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3
Q

WHO pain ladder

A
  1. Non-opioid (paracetamol/NSAID)
  2. Weak opioid (codeine) & non-opioid
  3. Strong opioid (morphine) & non-opioid
    Plus adjuvant analgesia if required at all steps
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4
Q

paracetamol

A

Analgesic and antipyretic actions
Minimal interactions or adverse effects
Used alone for mild to moderate pain or in combination for moderate to severe pain

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5
Q

Adult dose paracetamol

A

500mg tablets
2 tablets every 4-6 hours
Max of 8 tablets a day
In low weight adults - halve dose

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6
Q

Paracetamol dosing for children

A

Soluble tablets - 500mg
Paracetamol suspension 120mg/5ml or 250mg/5ml
Use age banding and consult child BNF

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7
Q

How do NSAIDs work

A

Inhibit prostaglandin synthetase (cyclo-oxygenase)
- cox 1 - constitutive - protects gastric mucousa
- cox 2 - inducible - inflammation
Anti-inflammatory activity leads to pain relief

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8
Q

Examples of NSAIDs

A

Ibuprofen, diclofenac, aspirin (rarely used)

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9
Q

Ibuprofen dosing

A 
Adults:
- 400mg tablets, 1 tablet 4x/day 
- can be increased if necessary to max daily dose of 2.4g
- maintenance dose: 600mg-1.2g a day
CHILDREN
- age banding, consult BNF
- tablets 200mg or supsension 100mg/5ml
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10
Q

Diclofenac

A
  • NSAID used for moderate inflammatory or post-op pain
  • Adults: 50mg tablets - 1 tablets 3x/day, or sustained rlease preparation
  • not recommended for children
  • stronger than ibuprofen
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11
Q

Drug-drug interactions with NSAIDs

A
  • increased risk of bleeding with antiplatelets, anticoagulants and SSRI’s
  • increased risk of AKI when used with nephrotoxins
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12
Q

Adverse effects of NSAIDs

A
  • GI - gastritis, bleeding, peptic ulcer
  • Cardio - MI, stroke
  • Renal dysfunction
  • Hypersensitivity reactions in a small proportions of asthmatics
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13
Q

How to avoid NSAID problems

A
  • prescribe lower risk drugs at lowest recommended dose
  • do not use more than 1
  • do not prescribe in patients with hypersensitivity
  • prescribe alongside a PPI in patients with previous/active peptic ulcer disease
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14
Q

Action, use and examples of weak opioids

A
  • act on CNS to alter the perception of pain
  • used for moderate-severe pain
  • e.g. codeine phophate and dihydrocodeine
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15
Q

ADRs of weak opiods

A
  • nausea
  • constipation
  • dependence
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16
Q

Dosing of weak opiods

A

ADULTS
- Codeine phosphate 30mg tablets: 1-2 tablets 4x/day (max 240mg/day)
- Dihydrocodeine 30mg tablets: 1 tablet 4x/day (max 120mg/day????)
Not recommended for use in kids due to morphine toxicity

17
Q

Problems with combination agents

A
  • reduction of scope to titrate individual componenets
  • increased with of s/e
  • increased danger from overdose
18
Q

Tramadol - mechanism, use and dose

A
  • opiod analgesic with enhanced 5HT and adrenergic pathways
  • for moderate to severe pain
  • adult dose: 50-100mg every 4 hours, max daily dose 400mg
19
Q

Problems with tramadol

A
  • subject to abuse

- s/e: n&v, drowsiness, respiratory depression, hypotension

20
Q

Strong opiods - use, mechanism and examples

A
  • for severe pain
  • act on mu and kappa receptors in CNS
  • analgesia/euphoria/sedation –> dependence
  • morphine, fentanyl, oxycodone, pethidine
21
Q

Contraindications to strong opiods

A

respiratory depression, hypotension, liver impairment

22
Q

Strong opiods - dosing in adults

A

pethidine 50mg tablets

- 50-100mg every 4 hours - max 450mg

23
Q

Problems with pethidine (strong opioid)

A
  • metabolised to norpethidiine which can accumulate in renal impairment
  • can stimulate the CNS and cause seizures
24
Q

Adjuvant agents - what are they, were do they act, what are they used for

A
  • drugs intended for indications other than pain, but are analgesic in select cirmcumstances
  • act centrally
  • used at lower doses than their usual indications
  • e.g. TCA’s for neuropathic pain, AEDs for neuropathic pain and trigerminal neuralgia, Anxiolytics for facial and back pain
25
Q

Adjuvant agents for neuropathic pain

A

TCA’s
- amitryptiline - 10mg/day increased up to 75mg
- noritriptyline, dosulepin
Antiepileptics
- gabapentin - 300mg 3x/day, up to 3.6g/day
- carbamazepine - 100mg 1-2x/day, up to 1.6g (requires FBC and LFT monitoring)

26
Q

Adjuvant agents used for facial and back pain

A

Anxiolytics

  • benxodiazepines (diazepam 2mg 3x/day)
  • short course - subject to abuse
27
Q

Cautions with analgesia in liver disease

A
  • increased risk of bleeding with NSAIDs
  • caution with paracetamol
  • opiods may be slowly metabolised and precipitate encephalopathy
28
Q

Cautions with analgesia in renal disease

A
  • NSAIDs may further increase renal impairment

- elimination of some drugs decreased - give lower doses

Therapeutics (17 decks)

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