Analgesics for optometry Flashcards
What are the indications for paracetamol?
First line analgesic for mild to moderate pain
- soft tissue or musculoskeletal pain
- mild procedural pain
- management of fever
How should paracetamol be given?
Unless contraindicated it should be given orally. They come in tablet, soluble tablets and capsule form.
What is the dosing for paracetamol?
2 tablets 4x a day for adults
paediatric dose - 15mg/kg/day, upto max adult dose
What are the precautions for paracetamol?
- chronic severe hepatic dysfunction
- reduce dose for px with low body weight
What are the indications for NSAIDS?
For mild to moderate pain especially if due to inflammation or tissue damage
e.g. period pain, metastatic bone pain, headache, migraine, rheumatoid arthritis
What are the two cyclo-oxygenase (cox) enzymes?
COX 1, COX 2
What is the role of COX 1 & COX 2 ?
Help convert arachidonic acid into prostaglandin E2.
- they are inhibited to stop prostaglandins being produced
What are the effects of COX 1?
- gastroprotection
- platelet aggregation
- maintenance of glomerular filtration rate
- renal blood flow
What do the NSAIDs of the eye do?
- miosis
- increased vascular permeability of the blood-ocular barrier
- conjunctival hyperemia
- changes in IOP
What are the two NSAIDs used for the eye?
- Flurbiprofen 0.03% - 1 drop 3-5 times a day
- Ketorolac 0.5% - 1 drop QID
What are the indications for Flurbiprofen?
- Corticosteroid-sparing agent or as an alternative to corticosteroids
- used as an analgesic following photorefractive surgery
What are the indications for Ketorolac?
Short-term treatment of seasonal allergic conjunctivitis
What are the adverse effects of NSAIDs in the eye?
- stinging, ocular irritation (most common)
- delayed epithelial growth and wound healing
What are the indications for Opioids?
moderate to severe pain
acute and chronic pain
What is the mechanism of action of Opioids?
They interact with opioid receptors (mu, kappa and delta) which reduces transmission of pain in the spinal cord
