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Year 3 - Met3a > Analgesia > Flashcards

Analgesia Flashcards

1
Q

What is the WHO pain ladder

A

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
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2
Q

List some non opioids

A
  • Paracetamol 1g four times a day
  • aspirin
  • NSIADS
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3
Q

what is paracetamol cautioned in

A
  • cautioned in liver impairment
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4
Q

Why is aspirin not given in children

A

due to risk of Reye’s syndrome

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5
Q

What is Reye’s syndrome

A

Reye’s syndrome is a very rare disorder that can cause serious liver and brain damage.

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6
Q

what are NSAIDS good for

A
  • Musculoskeletal pain

- renal/billary colic

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7
Q

What are NSAIDS contraindicated in

A
  • peptic ulcer
  • clotting disorders
  • anticoagulants
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8
Q

What are NSAIDS cautioned in

A
  • asthma
  • renal/hepatic impairment
  • heart failure
  • IHD
  • pregnancy
  • elderly
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9
Q

Name some weak opioids

A
  • 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)
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10
Q

What are the different strengths of co-codamol II

A

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)
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11
Q

what are the different strengths of co-dydramol II

A

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)
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12
Q

How much codeine is in morphine

A

codeine 10:1 morphine

- 240mg codeine = 24mg morphine

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13
Q

Name some strong opioids

A
  • morphine
  • diamorphine
  • oxycodone
  • fentanyl
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14
Q

What are the side effects of opioids

A
  • nausea
  • constipation
  • respiratory depression
  • cough suppression
  • urinary retention
  • low BP
  • sedation
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15
Q

What are adjuvants

A
  • these counter adverse effects of pain medication
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16
Q

What should you always prescribed with opiates

A
  • always prescribe laxative regular + anti-emetic PRN
17
Q

what should you prescribe for bone pain or inflammatory pain

A

NSAIDS

  • ibuprofen 400mg/8 hours
  • naproxen
18
Q

What should you prescribe for neuropathic pain

A

Anticonvulsants

  • gabapentin - 600-2400mg daily
  • pregabalin - 15mg at start increasing put to 600mg daily

or

TCAs
- amitriptyline 10-75mg daily

19
Q

what should you prescribe for metazoic bone disease in cancer pain

A

Bisphosphonates

  • disodium pamidroante
  • zoledronic acid
20
Q

What should you prescribe for neuropathic and inflammatory pain

A
  • dexamethasone
21
Q

What are the types of pain

A

Nociceptive

neuropathic

22
Q

What are the two types of nociceptive pain

A
  • Somatic

- Visceral

23
Q

Describe somatic nociceptive pain

A
  • aching, often constant
  • may be dull or sharp
  • often worse with movement
  • well localised
  • Treatment - WHO pain ladder
24
Q

Describe visceral nociceptive pain

A
  • constant or crampy
  • aching
  • poorly localised
  • referred
  • Treatment: WHO pain ladder
25
Q

How is neuropathic pain described

A
  • Described as or associated with – burning, shooting, pricking, numbness, tingling, sensitive, cold, itch
  • Allodynia, hyperalgesia, autonomic effects
26
Q

what is the first line treatment for neuropathic pain

A
  • TCAs (amitriptyline)
  • Gabapentin/pregabalin
  • Anticonvulsants (carbamazepine) – if trigeminal neuralgia
27
Q

What are the side effects of hyoscine and atropine

A

tachycardia, urinary retention, glaucoma, sedation

28
Q

What are the side effects of thiopental

A
  • laryngospasm
29
Q

What are the side effects of propofol

A
  • respiratory/cardiac depression

- pain on injection

30
Q

How does local anaesthetic toxicity present

A
  • peri-oral tingling and paraesthesiae

- progresses to drowsiness, seizures, coma and cardiorespiratory arrest

31
Q

How do you treat local anaesthetic toxicity

A
  • treatment is with lipid emulsion

Year 3 - Met3a (43 decks)

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