Central Nervous System - Pain Management Flashcards
non-opiates tx of mild pain?
paracetamol, ibuprofen, NSAID, aspirin
tx of mild-moderate pain?
-weak opiates = codeine/dihydrocodiene
-moderate = tramadol
s/e of tramadol
- lowers seizure threshold
- serotonin syndrome
- high risk of bleed
- psychiatric disorders
tx of moderate to severe pain?
strong opiates = morphine, oxycodone, methadone, buprenorphine, fentanyl
age requirement of codeine?
12+
when is codeine not given in children <18?
when they have their tonsils removed due to sleep apnea
why is codeine not given to Afro-Caribbean pt?
they have ultra rapid metaboliser than can cause codeine toxicity
can you give codeine in breast-feeding?
no
s/e of opiates
act on mu-pathway causing:
- dry mouth
- constipation
- CNS depression
- N+V
- hypotension
- miosis (pupil constriction)
what does prolonged use of strong opiates cause?
- hypogonadism
- adrenal insufficiency
- hyperalgesia
hyogonadism= decreased functional activity of gonads (ovaries/testes)
hyperalgesia = unusually severe pain in normal pain situations
tx of overdose in strong opiates?
naloxene
when do you avoid strong opiates?
- paralytic ileus
- respiratory disease
- head injury
what is breakthrough pain of strong opiates?
1/6th to 1/10th total daily dose every 2-4hr
how do you increase strong opiate doses?
increase by 1/2 to 1/3 each day
how do you decrease strong opiate doses?
-decrease by 1/2 to 1/3 when switching to avoid overdose
what is potent morphine or oxycodone?
oxycodone
when is oxycodone preferred than morphine?
in pt who cannot consume large amounts due to nausea
cautions regarding patches?
- avoid exposure to heat
- apply to dry, hairless skin
- rotate area
- remove immediately if toxicity signs especially fentanyl
what is tx of neuropathic pain?
-TCA
-Antiepileptics
-opiates
-topical localised
whichTCA is given as tx in neuropathic pain?
amitriptyline
nortriptyline
which topical localised drugs are given as tx in neuropathic pain?
lidocaine
capsaicin
which antiepileptics are given as tx in neuropathic pain?
gabapentin
pregablin
which opiates are given as tx in neuropathic pain?
morphine
oxycodone
pregnancy and pregabalin
- may slightly increase the risk of major congenital malformations
- use effective contraception during treatment
- avoid use in pregnancy unless clearly necessary.
