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230 - Pain > Analgesics > Flashcards

Analgesics Flashcards

1
Q

What are the WHO pain ladder recommendations?

A
  1. Non Opioid +/- adjuvants
  2. Weak opioid + non opioid +/- adjuvants
  3. Strong opiod + non opioid +/- adjuvants
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2
Q

What are the two types of non opioid?

A
  1. Paracetamol
  2. NSAIDS
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3
Q

How does paracetamol work and what is it used for?

A

Unknown mechanism

Reduces central prostaglandin synthesis - negligible anti inflammatory action

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4
Q

What is the main concern with paracetamol?

A

Overdose as it is so readily available

All the glutathione gets used - give n acetylcystein

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5
Q

What does paracetamol react with and who should not take it?

A

Nothing and no one

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6
Q

How do NSAIDS work?

A

Block COX enzymes

COX 1 - Gastroprotection, renal perfusion, platelet aggregation

COX 2- Inflammation and pain

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7
Q

What are the side effects of NSAIDS?

A

GI bleeds and problems

Kidney damage

Bronchospasm

Na, H20 retention

MI

This is because cant cause the drug to only block COX 2 and not COX 1

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8
Q

What are some weak opioids?

A

Codein

Dihydrocodeine

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9
Q

What is an intermediate opiate?

A

Tramadol

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10
Q

What are some strong opioids?

A

Fentanyl

Morphine

oxycodone

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11
Q

How do opiates work?

A

Stimulate centres in the brain for endogenous opiates and have direct effects

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12
Q

What are some non pain reducing side effects of opiates?

A

Constipation

Euphoria

Sedation

Respiratory/cough supression

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13
Q

What is an opiate reverser?

A

Naloxone

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14
Q

What opiate receptors are there?

A

Mew

Kappa

Delta

Mew - Mophine, fentanyl

All - Oxycodone

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15
Q

Alternatives - When would you use bisphosphonates?

A

Bone pain, eg cancer mets

Stops bone resorption

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16
Q

Alternatives - When would you use baclofen?

A

Muscle spasm pain

17
Q

Alternatives - What is an NMDA antagonist used for pain?

A

Ketamine - used post operatively or in trauma

18
Q

Alternatives - What are some anaesthetics?

A

Lidocaine - Blocks AP potential via blocking sodium channels

Entonox - NO and o2 - Child birth

19
Q

Alternatives - anti epileptic

A

Carbamazepine - Trigeminal neuralgia

20
Q

Alternatives - Cream

A

Capsaicin - causes over sensitization and dying back of sensory nerves

21
Q

What must be written down on discharge medicine for opiates?

A

Name and address handwritten

Specify dose/strength/form

State quantity in words and figures

SEE lecture handout

22
Q

What is 1st line for diabetes pain?

A

Duloxetine

23
Q

What is 1st line for trigeminal neuralgia?

A

Carbamazepine

230 - Pain (5 decks)

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