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Neurology- Physiology > Analgesia > Flashcards

Analgesia Flashcards

1
Q

Describe the WHO pain ladder for pharmacological management of pain?

A

Paracetamol, NSAID, weak opioid, strong opioid

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2
Q

Which aspects of the WHO pain ladder can be used in combination in moderate-severe pain?

A

Paracetamol and NSAID, or paracetamol and weak opioid

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3
Q

Opioid action is mediated by what?

A

GPCRs

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4
Q

What are the disadvantages of opioids?

A

Addictive, and numerous side effects

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5
Q

What is the main respiratory side effect of opioids?

A

Apnoea (respiratory depression)

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6
Q

What is the main cardiovascular side effect of opioids?

A

Postural hypotension

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7
Q

What are the main GI side effects of opioids?

A

Nausea and vomiting, constipation

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8
Q

What are some CNS side effects of opioids?

A

Confusion, euphoria, hallucinations

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9
Q

Opioid agonists produce analgesia mainly through prolonged activation of which type of receptor?

A

μ (Mu)

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10
Q

Give some examples of opioid agonists?

A

Morphine, diamorphine (heroin), codeine

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11
Q

Morphine is metabolised by the ? and excreted by the ?

A

Liver / kidneys

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12
Q

How is codeine always given? What is its main side effect?

A

Oral / constipation

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13
Q

Give some examples of opioid antagonists?

A

Naloxone and naltrexone

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14
Q

Opioid antagonists are competitively antagonist to which opioid receptor?

A

μ (Mu)

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15
Q

When is naloxone used?

A

To reverse opioid toxicity associated with severe overdose

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16
Q

How is naloxone given?

A

IV

17
Q

In opioid addicts, naloxone may trigger what?

A

An acute withdrawal response

18
Q

What makes naltrexone different from naloxone?

A

It can be given orally and has a longer half life

19
Q

How do NSAIDs work?

A

They inhibit prostaglandin production by blocking COX1 and COX2

20
Q

What are some adverse effects of long term NSAID use?

A

GI damage and nephrotoxicity

21
Q

Why is paracetamol not an NSAID?

A

It lacks anti-inflammatory effects and only acts centrally

22
Q

Gabapentin and pregabalin reduce the surface expression of a particular subunit, and also some of which type of ion channel which are upregulated in damaged sensory neurones?

A

Ca++

23
Q

What is a use of gabapentin?

A

Migraine prophylaxis

24
Q

What is a use of pregabalin?

A

Painful diabetic neuropathy

25
Q

How do tricyclics work?

A

They act centrally to decrease the reuptake of noradrenaline

26
Q

Apart from tricyclics, what other anti-depressants can be used for neuropathic pain? How do they work?

A

SNRIs / decrease reuptake of noradrenaline and serotonin

27
Q

How does carbamazepine work?

A

Blocks Na+ channels which are upregulated in damaged nerve cells

28
Q

What is an example of when carbamazepine would be used?

A

Trigeminal neuralgia

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