Analgesia Flashcards
What is the WHO pain ladder
Step 1
- non opioid - e.g. aspirin, paracetamol or NSAID
- adjuvant
Step 2 - mild to moderate pain
- weak opioid
- +/- non opioid
- +/- adjuvant
Step 3 - moderate to severe pain
- strong opioid
- +/- non opioid
- +/- adjuvant
List some non opioids
- Paracetamol 1g four times a day
- aspirin
- NSIADS
what is paracetamol cautioned in
- cautioned in liver impairment
Why is aspirin not given in children
due to risk of Reye’s syndrome
What is Reye’s syndrome
Reye’s syndrome is a very rare disorder that can cause serious liver and brain damage.
what are NSAIDS good for
- Musculoskeletal pain
- renal/billary colic
What are NSAIDS contraindicated in
- peptic ulcer
- clotting disorders
- anticoagulants
What are NSAIDS cautioned in
- asthma
- renal/hepatic impairment
- heart failure
- IHD
- pregnancy
- elderly
Name some weak opioids
- Tramadol 100mg qds
- Codeine 60mg qds
- Co-codamol II qds (I tablet contains different strength codeine + 500mg of paracetamol)
- Dihydrocodeine 60mg qds
- Co-dydramol II qds (I tablet contains different strength dihydrocodeine + 500mg of paracetamol)
What are the different strengths of co-codamol II
Co-codamol II qds (I tablet contains different strength codeine + 500mg of paracetamol)
- 8/500 (64mg/24h – hence ≈ equal to 1 dose of codeine)
- 10/500 (80mg/24h)
- 30/500 (240mg/24h)
what are the different strengths of co-dydramol II
Co-dydramol II qds (I tablet contains different strength dihydrocodeine + 500mg of paracetamol)
- 10/500 (80mg/24h)
- 20/500 (160mg/24h)
- 30/500 (340mg/24h)
How much codeine is in morphine
codeine 10:1 morphine
- 240mg codeine = 24mg morphine
Name some strong opioids
- morphine
- diamorphine
- oxycodone
- fentanyl
What are the side effects of opioids
- nausea
- constipation
- respiratory depression
- cough suppression
- urinary retention
- low BP
- sedation
What are adjuvants
- these counter adverse effects of pain medication
What should you always prescribed with opiates
- always prescribe laxative regular + anti-emetic PRN
what should you prescribe for bone pain or inflammatory pain
NSAIDS
- ibuprofen 400mg/8 hours
- naproxen
What should you prescribe for neuropathic pain
Anticonvulsants
- gabapentin - 600-2400mg daily
- pregabalin - 15mg at start increasing put to 600mg daily
or
TCAs
- amitriptyline 10-75mg daily
what should you prescribe for metazoic bone disease in cancer pain
Bisphosphonates
- disodium pamidroante
- zoledronic acid
What should you prescribe for neuropathic and inflammatory pain
- dexamethasone
What are the types of pain
Nociceptive
neuropathic
What are the two types of nociceptive pain
- Somatic
- Visceral
Describe somatic nociceptive pain
- aching, often constant
- may be dull or sharp
- often worse with movement
- well localised
- Treatment - WHO pain ladder
Describe visceral nociceptive pain
- constant or crampy
- aching
- poorly localised
- referred
- Treatment: WHO pain ladder
