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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
Which opioid analgesic is not recommended after myocardial infarction?
Pentazocine
26
Which opioid analgesic works by opioid agonism and noradrenaline reuptake inhibition?
Tapentadol
27
Which opioid analgesic works by opioid agonism and SNRI?
Tramadol
28
Give 2 examples of weak opioids
1. Codeine | 2. Dihydrocodeine
29
Which opioid is not recommended for the treatment of post operative pain?
Pethidine, converted to norpethidine which stimulates CNS and can lead to convulsions
30
Which device can be used post-operatively to deliver opioids?
PCA
31
Do doctors require a special license to treat patients with opioid dependence with opioids for organic disease?
NO
32
There is an increased risk of overdose in patients taking parecatamol if they are what? (2)
1. Less than 50kg | 2. Poor hepatic function
33
Paracetamol can interact with which drugs to cause toxicity?
Enzyme-inducing anti-epileptics
34
If someone overdoses on paracetamol, what are the only clinical features of this in the initial stages?
Nausea and vomiting
35
Paracetamol capsules and tablets can be sold to the public in packs no larger than how many?
32
36
What is the total amount of paracetamol tablets / capsules that can be sold OTC?
100
37
How can respiratory depression in opioid toxicity be reversed?
Using naloxone
38
As well as coma and respiratory depression, what is another sign of opioid toxicity?
Pin-point pupils
39
Can opioids be stopped abruptly after long term treatment?
No - gradual withdrawal
40
Fever and external heat can increase absorption from which patches?
Buprenorphine
41
What must be monitored before and throughout treatment with buprenorphine?
LFTs
42
Which 2 opioids are recommended for the treatment of substance misuse?
1. Buprenorphine | 2. Methadone
43
How long is supervised consumption for patients on buprenorphine and methadone for dependence?
3 months
44
Why can the activity of codeine vary so much between populations?
The capacity to metabolise codeine into morphine (active) can vary: ultra metabolisers, poor metabolisers
45
What are the 2 MHRA alerts for the use of codeine?
1. Restricted use in children due to reports of toxicity | 2. Codeine for cough and cold restricted for use in children
46
At which age should codeine be used only for the relief of moderate pain if it cannot be relieved by ibuprofen or paracetamol alone?
Over 12
47
In which children is there a serious risk of life-threatening adverse reactions? It is therefore contra-indicated
Children with obstructive sleep apnoea whi received it after tonsillectomy or adenoidectomy
48
What is the maximum duration of treatment for codeine in children 12-18?
3 days
49
In which children is codeine not recommended?
In those with compromised breathing (e.g. during infection, respiratory/cardiovascular disorders)
50
What does this mean "Fentanyl 25 patches"?
Fentanyl 25mcg/hr patches
51
How should used fentanyl patches be disposed?
Removed then folded in on themselves then disposed in a regular bin
52
Can fentanyl patches be cut?
No
53
Which CD is morphine 10mg/5mL?
CD5
54
What are the treatment options for migraine? (4)
1. Paracetamol 2. Aspirin 3. Anti-emetics 4. 5HT1 antgonists (e.g. Sumatriptan)
55
Can Sumatriptan be combined with Naproxen for treatment of migraine?
Yes
56
Why is it advantageous to treat N&V associated with migraines with Metoclopramide and Domeperidone?
1. Promote gastric emptying | 2. Promote normal peristalsis
57
Which drug can trigger migraines?
Combined hormonal oral contraceptives
58
If a patient suffers more than two migraines a month, what should be considered?
Prophylactic treatment
59
Which formulation of analgesia is most suitable for treating migraines?
Soluble/dispersible because peristalsis is reduced and tablets may not be well absorbed
60
Which class of drug, associated with cardiovascular treatment, can be effective in the prophylaxis of migraine?
Beta-blockers
61
Which is the most commonly used beta-blocker for the prophylaxis of migraine
Propranolol
62
Give 5 unlicensed treatments for migraine prophylaxis
1. TCAs 2. Topiramate 3. Sodium valproate 4. Valproic acid 5. Gabapentin
63
What are the active ingredients of migraleve yellow?
Paracetamol + Codeine
64
What are the active ingredients of migraleve pink?
Paracetamol + Codeine + Buclizine
65
How should migraleve tablets be taken for migraine?
TWO PINK tablets at onset TWO YELLOW tablets every 4 hours PRN MAX = 8 in one day
66
How should sumatriptan be taken for migraine?
1-2 tablets initially followed by 1-2 tablets after 3 hours if required
67
Can sumatriptan be sold OTC?
Yes, for previously diagnosed migraine
68
Give 5 causes of neuropathic pain
1. HIV infection 2. Diabetes 3. Chronic excessive alcohol 4. Chemotherapy 5. Idiopathic
69
What is postherpetic neuralgia?
Peripheral nerve damage following acute herpes zoster infection
70
Which drugs are generally used to manage neuropathic pain?
1. TCAs | 2. Anti-epileptics
71
Give an example of topical application which can be used to treat neuropathic pain in patients unable to tolerate oral medicines
Lidocaine plasters

BNF (28 decks)

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