Central Nervous System - Pain Management

Question 1

non-opiates tx of mild pain?

Answer 1

paracetamol, ibuprofen, NSAID, aspirin

Question 2

tx of mild-moderate pain?

Answer 2

-weak opiates = codeine/dihydrocodiene
-moderate = tramadol

Question 3

s/e of tramadol

Answer 3

• lowers seizure threshold
• serotonin syndrome
• high risk of bleed
• psychiatric disorders

Question 4

tx of moderate to severe pain?

Answer 4

strong opiates = morphine, oxycodone, methadone, buprenorphine, fentanyl

Question 5

age requirement of codeine?

Answer 5

12+

Question 6

when is codeine not given in children <18?

Answer 6

when they have their tonsils removed due to sleep apnea

Question 7

why is codeine not given to Afro-Caribbean pt?

Answer 7

they have ultra rapid metaboliser than can cause codeine toxicity

Question 8

can you give codeine in breast-feeding?

Answer 8

no

Question 9

s/e of opiates

Answer 9

act on mu-pathway causing:
- dry mouth
- constipation
- CNS depression
- N+V
- hypotension
- miosis (pupil constriction)

Question 10

what does prolonged use of strong opiates cause?

Answer 10

• hypogonadism
• adrenal insufficiency
• hyperalgesia

hyogonadism= decreased functional activity of gonads (ovaries/testes)

hyperalgesia = unusually severe pain in normal pain situations

Question 11

tx of overdose in strong opiates?

Answer 11

naloxene

Question 12

when do you avoid strong opiates?

Answer 12

• paralytic ileus
• respiratory disease
• head injury

Question 13

what is breakthrough pain of strong opiates?

Answer 13

1/6th to 1/10th total daily dose every 2-4hr

Question 14

how do you increase strong opiate doses?

Answer 14

increase by 1/2 to 1/3 each day

Question 15

how do you decrease strong opiate doses?

Answer 15

-decrease by 1/2 to 1/3 when switching to avoid overdose

Question 16

what is potent morphine or oxycodone?

Answer 16

oxycodone

Question 17

when is oxycodone preferred than morphine?

Answer 17

in pt who cannot consume large amounts due to nausea

Question 18

cautions regarding patches?

Answer 18

• avoid exposure to heat
• apply to dry, hairless skin
• rotate area
• remove immediately if toxicity signs especially fentanyl

Question 19

what is tx of neuropathic pain?

Answer 19

-TCA
-Antiepileptics
-opiates
-topical localised

Question 20

whichTCA is given as tx in neuropathic pain?

Answer 20

amitriptyline
nortriptyline

Question 21

which topical localised drugs are given as tx in neuropathic pain?

Answer 21

lidocaine
capsaicin

Question 21

which antiepileptics are given as tx in neuropathic pain?

Answer 21

gabapentin
pregablin

Question 21

which opiates are given as tx in neuropathic pain?

Answer 21

morphine
oxycodone

Question 22

pregnancy and pregabalin

Answer 22

• may slightly increase the risk of major congenital malformations
• use effective contraception during treatment
• avoid use in pregnancy unless clearly necessary.