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BNF > CHAPTER 4: CNS: Pain > Flashcards

CHAPTER 4: CNS: Pain Flashcards

1
Q

Which drug should be avoided in sickle cell disease?

A

Pethidine

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2
Q

Why should pethidine be avoided in sickle cell disease?

A

Accumulation of neurotoxic metabolite can precipitate seizures

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3
Q

In dental pain, analgesics can be used in the short term (up to a week) until what?

A

The cause has been identified and dealt with

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4
Q

Pain and discomfort associated with acute problems of the gastric mucosa may be relieved by which topical preparation?

A

Difflam

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5
Q

Which class of drug can relieve most dental pain?

A

NSAIDs

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6
Q

Which class of drug is relatively ineffective in dental pain?

A

Opioids

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7
Q

Any analgesic given before a dental procedure should have a low risk of increasing what?

A

Post-operative bleeding

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8
Q

If patients get anxiety due to pain before dental procedures (e.g. by clenching their teeth), which drug may be effective?

A

Diazepam

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9
Q

Which class of drug can be used as a long-term preventative measure of pain associated with dysmenorrhoea?

A

Oral anti contraceptive

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10
Q

Other than the oral contraceptive, which 2 drugs can be used for pain in dysmenorrhoea

A

Paracetamol and ibuprofen

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11
Q

Once known for its analgesic effect, which “NSAID” is now mainly used for its antiplatelet effect?

A

Aspirin

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12
Q

When should aspirin and other NSAIDs be taken to minimise GI effects?

A

After food

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13
Q

Aspirin interacts significantly with drugs, which interaction is a special hazard?

A

Aspirin and Warfarin

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14
Q

Paracetamol is a generally tolerable drug and can be used in children and the elderly. However, in which situation is it particularly dangerous?

A

in overdosage

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15
Q

How long can paracetamol overdose go undetected?

A

4-6 days

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16
Q

In which patients are NSAIDs contra-indicated? (5)

A
  1. Asthmatics
  2. Heart failure
  3. CKD
  4. Hyperkalaemia
  5. GORD
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17
Q

What are the side effects of opioids? (6)

A
  1. Constipation
  2. Respiratory depression
  3. Dependence
    4, Sedation
  4. Nausea
  5. Vomiting
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18
Q

Which combination product is no longer licensed due to safety concerns especially toxicity in overdose?

A

Co-proxamol (Dextropopoxyphene and Paracetamol)

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19
Q

What can repeated administration of opioids cause? (2)

A
  1. Dependence

2. Tolerance

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20
Q

In which situation should the risk of dependece and tolerance not be used as a deterrent?

A

Terminal illness

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21
Q

What is the most valuable opioid for severe pain?

A

Morphone

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22
Q

Which opioid has both agonist and antagonist properties?

A

Buprenorphine

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23
Q

In patients dependent on other opioids, what may buprenorphine precipitate?

A

Withdrawal symptoms and pain

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24
Q

Which opioid has a greater solubility than morphine so is often preferred in palliative care as larger doses can be administered in smaller volumes?

A

Buprenorphine

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25
Q

Which opioid analgesic is not recommended after myocardial infarction?

A

Pentazocine

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26
Q

Which opioid analgesic works by opioid agonism and noradrenaline reuptake inhibition?

A

Tapentadol

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27
Q

Which opioid analgesic works by opioid agonism and SNRI?

A

Tramadol

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28
Q

Give 2 examples of weak opioids

A
  1. Codeine

2. Dihydrocodeine

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29
Q

Which opioid is not recommended for the treatment of post operative pain?

A

Pethidine, converted to norpethidine which stimulates CNS and can lead to convulsions

30
Q

Which device can be used post-operatively to deliver opioids?

A

PCA

31
Q

Do doctors require a special license to treat patients with opioid dependence with opioids for organic disease?

A

NO

32
Q

There is an increased risk of overdose in patients taking parecatamol if they are what? (2)

A
  1. Less than 50kg

2. Poor hepatic function

33
Q

Paracetamol can interact with which drugs to cause toxicity?

A

Enzyme-inducing anti-epileptics

34
Q

If someone overdoses on paracetamol, what are the only clinical features of this in the initial stages?

A

Nausea and vomiting

35
Q

Paracetamol capsules and tablets can be sold to the public in packs no larger than how many?

A

32

36
Q

What is the total amount of paracetamol tablets / capsules that can be sold OTC?

A

100

37
Q

How can respiratory depression in opioid toxicity be reversed?

A

Using naloxone

38
Q

As well as coma and respiratory depression, what is another sign of opioid toxicity?

A

Pin-point pupils

39
Q

Can opioids be stopped abruptly after long term treatment?

A

No - gradual withdrawal

40
Q

Fever and external heat can increase absorption from which patches?

A

Buprenorphine

41
Q

What must be monitored before and throughout treatment with buprenorphine?

A

LFTs

42
Q

Which 2 opioids are recommended for the treatment of substance misuse?

A
  1. Buprenorphine

2. Methadone

43
Q

How long is supervised consumption for patients on buprenorphine and methadone for dependence?

A

3 months

44
Q

Why can the activity of codeine vary so much between populations?

A

The capacity to metabolise codeine into morphine (active) can vary: ultra metabolisers, poor metabolisers

45
Q

What are the 2 MHRA alerts for the use of codeine?

A
  1. Restricted use in children due to reports of toxicity

2. Codeine for cough and cold restricted for use in children

46
Q

At which age should codeine be used only for the relief of moderate pain if it cannot be relieved by ibuprofen or paracetamol alone?

A

Over 12

47
Q

In which children is there a serious risk of life-threatening adverse reactions? It is therefore contra-indicated

A

Children with obstructive sleep apnoea whi received it after tonsillectomy or adenoidectomy

48
Q

What is the maximum duration of treatment for codeine in children 12-18?

A

3 days

49
Q

In which children is codeine not recommended?

A

In those with compromised breathing (e.g. during infection, respiratory/cardiovascular disorders)

50
Q

What does this mean “Fentanyl 25 patches”?

A

Fentanyl 25mcg/hr patches

51
Q

How should used fentanyl patches be disposed?

A

Removed then folded in on themselves then disposed in a regular bin

52
Q

Can fentanyl patches be cut?

A

No

53
Q

Which CD is morphine 10mg/5mL?

A

CD5

54
Q

What are the treatment options for migraine? (4)

A
  1. Paracetamol
  2. Aspirin
  3. Anti-emetics
  4. 5HT1 antgonists (e.g. Sumatriptan)
55
Q

Can Sumatriptan be combined with Naproxen for treatment of migraine?

A

Yes

56
Q

Why is it advantageous to treat N&V associated with migraines with Metoclopramide and Domeperidone?

A
  1. Promote gastric emptying

2. Promote normal peristalsis

57
Q

Which drug can trigger migraines?

A

Combined hormonal oral contraceptives

58
Q

If a patient suffers more than two migraines a month, what should be considered?

A

Prophylactic treatment

59
Q

Which formulation of analgesia is most suitable for treating migraines?

A

Soluble/dispersible because peristalsis is reduced and tablets may not be well absorbed

60
Q

Which class of drug, associated with cardiovascular treatment, can be effective in the prophylaxis of migraine?

A

Beta-blockers

61
Q

Which is the most commonly used beta-blocker for the prophylaxis of migraine

A

Propranolol

62
Q

Give 5 unlicensed treatments for migraine prophylaxis

A
  1. TCAs
  2. Topiramate
  3. Sodium valproate
  4. Valproic acid
  5. Gabapentin
63
Q

What are the active ingredients of migraleve yellow?

A

Paracetamol + Codeine

64
Q

What are the active ingredients of migraleve pink?

A

Paracetamol + Codeine + Buclizine

65
Q

How should migraleve tablets be taken for migraine?

A

TWO PINK tablets at onset
TWO YELLOW tablets every 4 hours PRN
MAX = 8 in one day

66
Q

How should sumatriptan be taken for migraine?

A

1-2 tablets initially followed by 1-2 tablets after 3 hours if required

67
Q

Can sumatriptan be sold OTC?

A

Yes, for previously diagnosed migraine

68
Q

Give 5 causes of neuropathic pain

A
  1. HIV infection
  2. Diabetes
  3. Chronic excessive alcohol
  4. Chemotherapy
  5. Idiopathic
69
Q

What is postherpetic neuralgia?

A

Peripheral nerve damage following acute herpes zoster infection

70
Q

Which drugs are generally used to manage neuropathic pain?

A
  1. TCAs

2. Anti-epileptics

71
Q

Give an example of topical application which can be used to treat neuropathic pain in patients unable to tolerate oral medicines

A

Lidocaine plasters

BNF (28 decks)

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