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afsha - pain > analgesics > Flashcards

analgesics Flashcards

1
Q

pain relief for mild sickle cell crisis (when blood vessels to part of the body become blocked)

A

paracetamol, NSAID, codeine, dihydrocodeine

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2
Q

pain relief for severe sickle cell crisis

A

morphine or diamorphine may be required
concomitant use of NSAID may potentiate analgesia and allow lower doses of opioid

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3
Q

pain relief for severe sickle cell crisis can comprise of morphine or diamorphine, concomitant use of NSAID can potentiate analgesia and allow for lower doses of opioid to be used. why should pethidine be avoided if possible? (2)

A

accumulation of neurotoxic metabolite can precipitate seizures
also relatively short half life means frequent injections

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4
Q

dental and orofacial pain - analgesics as a temporary measure until cause of pain has been dealt with. e.g. pain and discomfort associated with acute problems or oral mucosa (e.g. acute herpetic gingiostomatitis, erythema multiforma) can be relieved by … until cause of mucosal disorder has been dealt with

A

benzydamine mouthwash or spray

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5
Q

most dental pain is relieved effectively by this drug class

A

NSAIDs - ibuprofen, aspirin, diclofenac

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6
Q

is opooid needed for deltal pain

A

rarely required.
paracetamol, ibuprofen or aspirin are adequate for most cases
combining non opioid with opioid analgesic can provide greater relief of pain than either analgesic given alone, but only when an adequate dose of each analgesic is used

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7
Q

important thing to consider when giving analgesic before dental procedure

A

needs to have low risk of increasing post op bleeding

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8
Q

T or F - In the case of pain after dental procedure, taking an analgesic before the effect of the LA has worn off can improve control

A

true

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9
Q

post op dental procedure analgesia with ibuprofen or aspirin is usually continued for ?

A

24-72h

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10
Q

Temporomandibular dysfunction - what is it

A

This is a condition affecting movement of the jaw and can cause pain and stiffness around the jaw, ear and temple
Symptoms include pain around draw and clicking or grinding noise when moving jaw

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11
Q

Temporomandibular dysfunction may be related to

A

anxiety in some patients who may clench or grind their teeth during the day or night

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12
Q

Temporomandibular dysfunction - The muscle spasm (which appears to be the main source of pain) may be treated empirically with …..
and these may also be used ….

A

an overlay appliance which provides a free sliding occlusion and may also interfere with grinding

Diazepam which has muscle relaxant and anxiolytic properties may be helpful but should only be prescribed on short term basis during acute phase
Analgesics such as aspirin or ibuprofen may also be used

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13
Q

dysmenorrhea (period pain) - what can you take

A

Use of oral contraceptive prevents pain of dysmenorrhea which is generally associated with ovulatory cycles
Paracetamol or NSAID said will generally provide adequate relief for pain
Vomiting and severe pain associated with dysmenorrhea in women with endometriosis may require antiemetics in addition to analgesic
Antispasmodic such as alverine citrate have been advocated for dysmenorrhea but the antispasmodic action doesn’t generally provide significant relief

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14
Q

overdosage of paracetamol is dangerous because

A

can cause hepatic damage which is sometimes not apparent for 4-6 days

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15
Q

nefopam is a non opioid analgesic. when can it be used and what are the adv + disadvantages?

A

May have a place in the relief of persistent pain unresponsive to other non opioid analgesics
Causes little or no respiratory depression
However it has sympathomimetic (e.g. HTN, hyperthermia, tachycardia and anti muscarinic side effects
Interactions: MAOIs - severe HTN

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16
Q

what can you use in preference to non-selective NSAIDs for pt at high risk of developing serious GI SE?

A

cox-2 inhibitors

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17
Q

ziconotide and its use and its route of Amin

A

non opioid analgesic
Administered by intrathecal infusion
Licence for treatment of chronic severe pain
Can be used by hospital specialist as adjunct to opioid analgesics

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18
Q

use of caffeine in compound analgesic preparations

A
  • weak stimulant
  • often included in small doses in analgesic preps
  • claimed that adding it may enhance analgesic effect
  • however alerting effect, mild habit forming effect and possible provocation of headache may not always be desirable
  • in excessive dosage or on withdrawal caffeine may induce headache
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19
Q

opioids are usually used to relieve moderate to severe pain, particularly of …. origin

A

visceral

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20
Q

Morphine is the standard against which other opioids are compared to. it is the opioid of choice for oral treatment of severe pain in palliative care. how often is it given?

A

regularly every 4 hours
or every 12 or 24 hours as MR pre

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21
Q

MOA buprenorphine

A

partial opioid receptor agonist - has both agonist and antagonist properties
it can precipitate withdrawal symptoms including pain in pt dependent on other opioids

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22
Q

true or false - effects of buprenorphine are only partially reversed by naloxone unlike other opioids

A

true

23
Q

true or false - buprenorphine has abuse potential and can cause dependence

A

true

24
Q

morphine vs buprenorphine - which one has longer duration of action

A

buprenorphine

25
Q

dipipanone vs morphine - used alone, which one is more sedating

A

morphine

26
Q

this drug is not suitable for regular regimens in palliative care because the only preparation available contains an antiemetic

A

dipipanone

27
Q

diamorphine aka

A

heroin

28
Q

heroin - drug name

A

diamorphine

29
Q

true or false - diamorphine (heroin) can cause less nausea and hypotension than morphine

A

true

30
Q

what is useful about diamorphine in palliative care & emaciated pt

A

greater solubility allows effective doses to be injected in smaller volumes
this is important in emaciated patients

31
Q

how often is fentanyl patch changed

A

72h

32
Q

alfentanil, fentanyl and remifentanil are used by injection for …

A

intra operative analgesia

33
Q

true or false - methadone is less sedating than morphine and acts for longer periods

A

true

34
Q

in prolonged use, methadone should only be administered. ….. to avoid risk of accumulation and opioid overdose

A

BD

35
Q

methadone can be used instead of morphine in the occasional patient who experiences …

A

excitation or exacerbation of pain with morphine

36
Q

a patient has their pain exacerbated with morphine. what can you give instead

A

methadone

37
Q

what is commonly used 2nd line if morphine is not tolerated or does not control pain

A

oxycodone
has an efficacy and SE profile similar to morphine

38
Q

MOA pentacozine

A

Pentazocine is an opioid agonist and a partial opioid antagonist.
Also serotinergic - risk of serotonin syndrome!!
Precipitates withdrawal symptoms including pain in patients dependent on other opioids

39
Q

pentazocine injection info

A

By injection it is more potent than dihydrocodeine or codeine, but hallucinations and thought disturbances can happen
Not recommended

40
Q

true or false - avoid pentazocine after MI as it may increase pulmonary and aortic BP as well as cardiac work

A

true

41
Q

pethidine is less constipating than morphine - T or F

A

true

42
Q

use of pethidine

A

acute pain, post op pain, pre medication
obstetric analgesia ( labour)

43
Q

pethidine produces prompt but short lasting analgesia. even in higher doses it is less potent. therefore it is not suitable for

A

severe continuing pain

44
Q

tapendatol produces analgesia by 2 mechanisms

A

Opioid receptor agonist
Also inhibit noradrenaline reuptake

45
Q

true or false - tapendatol nausea vomiting and constipation is less likely to occur than with other strong opioid analgesics

A

true

46
Q

mhra - tapendatol

A

Seizure Risk: Tapentadol may induce seizures and should be used cautiously in patients with a history of seizures or epilepsy. This risk is heightened if tapentadol is combined with other drugs that also lower the seizure threshold, such as: SSRIs, SNRIs, TCAs, antipsychotics

Serotonin Syndrome: There are reports of serotonin syndrome when tapentadol is co-administered with serotonergic antidepressants. If serotonin syndrome develops, discontinuing the serotonergic agent and providing supportive symptomatic care usually leads to rapid improvement.

47
Q

tramadol produces analgesia by two mechanisms

A

Opioid effect
Enhances serotoninergic and adrenergic pathways

48
Q

advantages of tramadol re side effects

A

Has fewer typical opioid side effects e.g. Less respiratory depression, less Constipation, less addiction potential
BUT psychiatric reactions have been reported

49
Q

Meptazinol - weak opioid. discuss SE and length of action

A

Claimed to have low incidence of respiratory depression
Has a reported length of action of 2-7 hours with onset within 15 minutes

50
Q

Pain management in pt with opioid dependence

A

Although caution is necessary, patients who are dependent on opioid or have history of drug dependence may be treated with opioid analgesics when there is a clinical need
Treatment with opioid analgesics in this patient group should normally be carried out with the advice of specialists
However doctors do not require special licence to prescribe opioid analgesics to patients with opioid dependence for relief of pain due to organic disease or injury

51
Q

why should you give post op opioid analgesia with care

A

it may potentiates any residual respiratory depression

52
Q

is buprenorphine recommended for post op analgesia

A

may antagonise the analgesic effect of previously administered opioids and is generally not recommended

53
Q

is pethidine recommended for post op analgesia

A

Pethidine generally not recommended because it is metabolised to norpethidine which may accumulate, particularly in RI
Norpethidine also stimulates CNS and may cause convulsions

afsha - pain (9 decks)

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