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
What are the side effects of opioids?
constipation, drowsiness, nausea and vomiting
- they are at risk of delirium, confusion, dry mouth and visual disturbances
What is Codeine?
- very weak opioid
useful for cough suppressant
useful to slow gastric motility and slow stomal output
What are the doses needed for Codeine?
doses of 30-60mg needed for analgesia
What is Tramadol?
Affects opioid, serotonin and noradrenaline receptors
- indicated for mild to moderate pain
What are the side effects of Tramadol?
Nausea - affects up to 25% of px
vomiting - affects up to 10% of px
dizziness - affects up to 30% of px
