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Pharmacy Pre-Reg 2020/2021 > Chapter 4 - Pain > Flashcards

Chapter 4 - Pain Flashcards

1
Q

What is the difference between acute and chronic pain?

A

Acute - less than 12 weeks

Chronic - more than 12 weeks

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2
Q

How is pain managed in children under 16 years?

A

Paracetamol or ibuprofen
Switch to the other
Alternate between both

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3
Q

How frequently is paracetamol given?

A

Every 4-6 hours

Maximum 4 doses per day

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4
Q

How frequently is ibuprofen given?

A

Every 8 hours

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5
Q

Describe the who analgesic ladder

A

Step 1. Non-opioids
Step 2. Mild opioids
Step 3. Strong opioids

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6
Q

How frequently should analgesics be reviewed in chronic pain?

A

At least annually

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7
Q

Is paracetamol:

a) antipyretic
b) anti inflammatory
c) analgesic

A

a and c

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8
Q

What is the maximum recommended paracetamol dose in

a) >50 kg
b) <50 kg

A

a) 4g

b) 2g

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9
Q

Why is paracetamol preferred over NSAIDs, especially in the elderly?

A

Less irritating to the stomach

Less CV and GI complications

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10
Q

What is the maximum pack size of paracetamol that can be sold to the public?

A

32

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11
Q

What is the maximum number of paracetamol tablets/capsules that can be sold to the public?

A

100

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12
Q

What are the dangers associated with paracetamol overdose?

A

Hepatocellular necrosis

Renal tubular necrosis (less common)

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13
Q

What single dosage of paracetamol may cause hepatocellular necrosis?

A

Generally 10g, or 75mg/kg taken in less than 1 hour

Or 5g if risk factors are present

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14
Q

What are the risk factors for paracetamol overdose?

A 
Alcohol dependency
Malnutrition 
Chronic dehydration 
Body weight <50kg
Severe liver disease
Increasing age
Concomitant use of hepatic enzyme inducers e.g. rifampin, phenytoin
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15
Q

What are the symptoms associated with paracetamol overdose?

A

Initially nausea and vomiting

Liver related side effects may occur later

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16
Q

How is paracetamol overdose managed?

A

If above the treatment line, use IV acetylcysteine

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17
Q

How soon should acetylcysteine ideally be given in paracetamol overdose?

A

Within 8 hours

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18
Q

NSAIDs have a strong anti-inflammatory action?

A

Ketoprofen

Piroxicam

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19
Q

NSAIDs have a moderate anti-inflammatory action?

A

Ibuprofen, naproxen

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20
Q

What is the mechanism of action of NSAIDs?

A

Inhibit COX-1 and COX-2

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21
Q

What is the effect of inhibiting COX-1 enzymes?

A

GI irritation due to reducing prostaglandin production

Inhibiting platelet aggregation due to reducing the production of thromboxane A2, so increasing the risk of bleeding

Regulates GFR

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22
Q

What is the effect of inhibiting COX-2 enzymes?

A

Reduces pain
Reduces inflammation
Reduces fever

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23
Q

What is the main advantage of selective NSAIDS over non-selective NSAIDs?

A

Reduced GI side effects

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24
Q

What is the main disadvantage of selective NSAIDS over non-selective NSAIDs?

A

Increased cardiovascular side effects

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25
Q

If a patient with CVD risk factors requires and NSAID, what should be given?

A

Non-selective NSAID + PPI

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26
Q

Give some examples of non-selective NSAIDs

A 
Ibuprofen 
Naproxen 
Mefanamic acid
Diclofenax
Meloxicam
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27
Q

Give some examples of selective NSAIDs

A

Celecoxib

Etoricoxib

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28
Q

Why should NSAIDs be taken with food?

A

To reduce gastric irritation

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29
Q

List some side effects of NSAIDs

A 
GI side effects
CV side effects 
Renal impairment 
Fluid retention 
Bronchospasm in some patients
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30
Q

Which NSAIDs have the highest risk of GI side effects?

A

Piroxicam

Ketoprofen

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31
Q

Which NSAIDs have the lowest risk of GI side effects?

A

Ibuprofen
Etoricoxib
Celecoxib

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32
Q

Which NSAIDs have the highest risk of cardiovascular side effects?

A

COXIBs
Diclofenac
Ibuprofen daily dose >2.4g

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33
Q

Which NSAIDs have the lowest risk of cardiovascular side effects?

A

Ibuprofen daily dose <1.2g

Naproxen

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34
Q

List some cautions/contraindications of NSAIDs

A 
Severe heart failure
Uncontrolled hypertension 
Previous GI ulcer
Asthma
History of NSAID hypersensitivity 
Renal impairment 
On an anticoagulant
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35
Q

How do NSAIDs worsen hypertension and heart failure?

A

Vasoconstriction

Reducing sodium and water excretion

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36
Q

How do NSAIDs cause sodium and water retention?

A

Block the production of PGE2, which regulates sodium, chloride and water transport in the LoH

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37
Q

At what eGFR do most NSAIDs need to be avoided in?

A

<30

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38
Q

Should NSAIDs be used in pregnancy?

A

Avoid unless the benefit outweighs the risk

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39
Q

Why isn’t phenylbutazone often used?

A

It is associated with serious side effects, especially haematological side effects

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40
Q

When are celecoxib and etoricoxib used?

A

Both:
Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis

Etoricoxib is also used for acute gout

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41
Q

What are the disadvantages of compound preparations for pain?

A

They can not be easily titrated

There are more side effects

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42
Q

Why were co-proximal tablets discontinued?

A

Concerns over safety
Toxic in overdose
Many people were using it to commit suicide

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43
Q

List some CNS depressants

A 
Opioids
Sedatives
Benzodiazepines 
Phenothiazines
Alcohol
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44
Q

What is the maximum daily dose of codeine?

A

240mg

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45
Q

What is the minimum age codeine can be given to?

A

12 years old

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46
Q

When shouldn’t codeine be given in 12-18 year olds

A

People with breathing difficulties

People who have had tonsillectomy for sleep apnoea

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47
Q

What is the maximum daily dose of dihydrocodeine?

A

180mg

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48
Q

What is the usual daily dose and maximum daily dose of tramadol?

A

Usual dose - 50-100mg every 4-6 hours when required

Maximum daily dose - 400mg

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49
Q

What produces more opioid like side effects, codeine or tramadol?

A

Codeine

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50
Q

What is the interaction between tramadol and SSRIs?

A

Both increase the risk of serotonin syndrome

Both lower the seizure threshold

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51
Q

What class of drug is tramadol?

A

Schedule 3 CD

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52
Q

How frequently is immediate release morphine given?

A

Every 4 hours

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53
Q

How frequently is modified release morphine given?

A

Every 12 hours

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54
Q

What drug is usually given second line if morphine is not effective or not tolerated?

A

Oxycodone

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55
Q

Which opioid is only partially reversed by naloxone in overdose?

A

Buprenorphine

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56
Q

What has a longer duration of action, immediate release morphine, or buprenorphine?

A

Buprenorphine

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57
Q

What are the advantages of diamorphine over morphine?

A

May cause less side effects including nausea and hypotension

May be preferred in syringe drivers as it has a greater solubility, so a smaller dose can be administered in the same volume

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58
Q

Which is more sedating, methadone or morphine?

A

Methadone

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59
Q

Which has a higher tendency to cause nausea, vomiting and constipation, morphine or tapentadol?

A

Morphine

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60
Q

Why should pentazocaine be avoided after an MI?

A

In can increase blood pressure and cardiac work

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61
Q

Does pethidine produce short or long lasting analgesia?

A

Short acting

This makes it useful for labour?

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62
Q

What is the main issue with pethidine?

A

It is metabolised to norpethidine, which may cause convulsions

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63
Q

When is dependable to opioids not a concern?

A

In palliative care

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64
Q

What is tolerance?

A

When a person no longer responds to a drug in the way that they used to

So a higher dose is required to produce the same effect

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65
Q

What is dependance?

A

When a person feels like they need to take a drug

They may have difficulty controlling its use

They may experience withdrawal symptoms when the dose is reduced or stopped

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66
Q

Can codeine be used in renal impairment?

A

Caution in mild to severe impairment

Avoid in severe impairment

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67
Q

Can morphine be used in renal impairment?

A

Yes, but it is not the recommended opioid and an alternative should be used

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68
Q

Why is morphine not recommended in renal impairment?

A

It’s active metabolite (MG6) accumulates in renal impairment

MG6 has a greater effect that morphine, so it’s accumulation can result in toxicity and increased side effects

Try to give an alternative that doesn’t accumulate in renal impairment, such as oxycodone, buprenorphine or fentanyl

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69
Q

Why is fentanyl appropriate in renal impairment?

A

It is metabolised into inactive, non-toxic metabolites

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70
Q

Why is oxycodone appropriate in renal impairment?

A

It doesn’t accumulate in renal impairment

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71
Q

Why is buprenorphine appropriate in renal impairment?

A

It is primarily excreted in the bile

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72
Q

How is the pain in sickle cell disease managed?

A

Paracetamol
NSAIDs
Weak opioids
Strong opioids

Use of an NSAID alongside opioids may potentiate analgesia and allow for lower doses of opioids to be used

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73
Q

What alangesia can be used in dental pain?

A

Benzydamine
Paracetamol
NSAIDs - don’t give anything that increases bleeding before a dental procedure

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74
Q

What can be used for temporomandibular dysfunction?

A

Diazepam can be used in the short term
It can help with both the pain and anxiety

Long term, NSAIDs can be used for the pain

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75
Q

What is temporomandibular dysfunction?

A

When people grind or clench their teeth in the day or night
It can be related to anxiety
And if can cause muscle spasm

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76
Q

How is the pain associated with dysmenorrhea managed?

A

Oral contraceptive
Paracetamol/NSAID
Antiemetic if needed
Antispasmodic

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77
Q

What is patient controlled analgesia?

A

When there is a background infusion of analgesic

If needed, a person can increase their analgesic dose up to a predetermined level

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78
Q

Can codeine be used in pregnancy and breastfeeding?

A

Pregnancy - yes

Breastfeeding - no

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79
Q

Which trimesters can codeine be given in pregnancy?

A

All in the short term

But if taken near labour, it may cause neonatal respiratory depression

If taken long term it may cause withdrawal symptoms in the baby

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80
Q

What is the paracetamol dose for a 4 month old baby?

A

60mg every 4-6 hours

Maximum 4 doses daily

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81
Q

What is the paracetamol dose for a 6 year old child?

A

240-250mg every 4-6 hours

Maximum 4 doses daily

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82
Q

What is the paracetamol dose for an 8 year old child?

A

360-375mg every 4-6 hours

Maximum 4 doses daily

83
Q

What is the paracetamol dose for a 16 year old?

A

0.5-1g every 4-6 hours

Maximum 4 doses daily

84
Q

What are the cautions of paracetamol?

A

Body weight under 50kg
Hepatic impairment
Malnutrition
Chronic alcohol consumption

85
Q

What is the ibuprofen dose for a 9 month old?

A

50mg three-four times a day

86
Q

What is the ibuprofen dose for a 2 year old?

A

100mg three times a day

87
Q

What is the paracetamol dose for a 6 year old?

A

150 mg TDS

88
Q

What is the paracetamol dose for a 13 year old?

A

300-400mg three-four times a day

Can go up to 600mg four times a day

89
Q

What dose of ibuprofen should be avoided in heart failure?

A

Above 2.4g daily

90
Q

What is used for ibuprofen overdose?

A

Activated charcoal if >100mg/kg is ingested within the preceding 1 hour

91
Q

When can naproxen be sold to the public?

A

For 15-50 year olds
With dysmenorrhea

Maximum 500mg per dose
Maximum 750mg per day
Maximum 3 days

Can sell 9 x 250mg tablets

92
Q

What should be done if a person is taking celecoxib and fluconazole?

A

Half the dose of celecoxib

93
Q

How should diclofenac gel not be used?

A

Don’t use with bandages
Don’t use of broken skin
Don’t use on mucous membranes

94
Q

Why isn’t piroxicam used first line?

A

Risk of serious GI and skin side effects

95
Q

How is the risk of serious GI and skin side effects of piroxicam reduced?

A

Only prescribe for OA, RA, and ankylosing spondylitis
Don’t use for general inflammation or pain

Don’t prescribe first line

Co-prescribe a PPI

Maximum 20mg daily

96
Q

What is the main issue associated with tifaprofenic acid?

A

Can cause severe cystitis

97
Q

What important safety information is associated with opioids?

A

Risk of fatal respiratory depression

Risk of dependance and addiction

98
Q

What is respiratory depression?

A

When ventilation isn’t adequate

99
Q

When is the risk of opioid induced respiratory depression increased?

A

Opioid naive patients

When opioids are used alongside another CNS depressant

100
Q

What are the contraindications and cautions of opioids?

A

Contraindications
Head injury or raised intracranial pressure
Acute respiratory depression

Cautions
History of mental heath disorders 
History of substance misuse
Sleep apnoea
Asthma
Convulsive disorders 
Hypotension 
Hypothyroidism
101
Q

What are the main side effects associated with opioids?

A

Respiratory depression
Addiction, tolerance, withdrawal

Constipation 
Nausea and vomiting 
Sedation
Dry mouth
Hallucinations 
Hypotension
102
Q

What is used for opioid overdose?

A

Naloxone

103
Q

List some withdrawal symptoms associated with opioids

A 
Irritability 
Nausea and vomiting 
Diarrhoea 
Muscle aches
Shivering
Sweating 
Difficulty sleeping
104
Q

What classes of drug can cause CNS depression?

A

Opioids
Benzodiazepines
Barbiturates
Alcohol

105
Q

What patient counselling should be given with opioids?

A

Symptoms of tolerance and respiratory depression

Driving may be influenced
It may be an offence to drive if you take too much, even if driving is not impaired

Effects of alcohol are increased

Treatment may not work straight away

106
Q

What is the minimum licensed age of ibuprofen?

A

3 months

107
Q

What is the minimum licensed age of fentanyl?

A

2 years

108
Q

What is the minimum licensed age of buprenorphine?

A

6 years

109
Q

What is the minimum licensed age of morphine?

A

1 month

110
Q

What is the minimum licensed age of tramadol?

A

12 years

111
Q

What is the minimum licensed age of oxycodone?

A

18 years (adult)

112
Q

What is the minimum licensed age of methadone?

A

18 years (adult)

113
Q

Why can’t breastfeeding mothers take codeine?

A

Approximately 10% of people can’t convert codeine to morphine

Risk of overdose

114
Q

How long can codeine be used for OTC?

A

3 days

115
Q

What important safety information is associated with codeine?

A

Risk of respiratory depression when used with benzodiazepines

Risk of tolerance, addiction and withdrawal

Contraindications in obstructive sleep apnoea in children I’m who have had a tonsillectomy or adenoidectomy

116
Q

What are the symptoms of morphine toxicity?

A

Respiratory depression
Pinpoint pupils
Nausea and vomiting

117
Q

Can codeine be used in pregnancy?

A

Yes

But may cause withdrawal symptoms in the neonate if taken during delivery

118
Q

Why is codeine generally preferred over tramadol?

A

It is not a CD

It has fewer withdrawal symptoms

119
Q

Why shouldn’t tramadol be given in epilepsy?

A

It lowers the seizure threshold

120
Q

Should patients start on immediate release morphine or modified release morphine?

A

Immediate release (every 4 hours)

Once the pain is controlled can switch to modified release

121
Q

How much of the total daily dose of morphine is the breakthrough pain dose?

A

1/6 to 1/10

122
Q

What brand is immediate release morphine?

A

Sevredol

123
Q

What brand is the 12 hour modified release morphine tablet?

A

MST

Morphgesic SR

124
Q

What brand is the 12 hour modified release morphine capsule?

A

Zomorph

125
Q

What brand is the 24 hour modified release morphine?

A

MXL

126
Q

What classification is morphine?

A

Schedule 2 CD

If the strength of an oral solution is less than 13mg/5ml, it’s a schedule 5

127
Q

What are the additional prescription requirements for morphine suppositories?

A

The morphine salt

128
Q

If a patient has chronic constipation, is morphine or oxycodone preferred?

A

Morphine

Oxycodone is contraindicated in chronic constipation

129
Q

What is the maximum daily oxycodone dose?

A

400mg

130
Q

What brand is the immediate release oxycodone?

A

Shortec

Oxynorm

131
Q

What brand is the 12 hour modified release oxycodone tablet?

A

Longtec

Oxylan

132
Q

What brand is the 24 hour modified release morphine?

A

Onexilia XL

133
Q

What are the main risks associated with tapentadol?

A

Can induce convulsions

Serotonin syndrome

134
Q

What is the brand name of tapentadol?

A

Pradexa

135
Q

Why is methadone good for use in addiction?

A

It has a long half life

136
Q

What are the interactions associated with methadone?

A

Other CNS depressants
Buprenorphine
Bendroflumethiazide (increased risk of hypokalaemia)
Amiodarone (QT interval prolongation)

137
Q

How of fentanyl used for breakthrough pain?

A

Use 200mcg buccal tablets
Take one
Take another after 15 mins if required

No more than two tablets per pain episode
If needing more than 4 doses, adjust background analgesia

138
Q

Why should extremes of body weight be considered with fentanyl?

A

To avoid overdosing in obese patients

Should use IBW

139
Q

Are different fentanyl formulations bioequivalent?

A

No

If switching you need to retitrate the dose

140
Q

Are all formulations of fentanyl cost effective?

A

Yes - patch

No - nasal spray, buccal tablet etc

141
Q

Can fentanyl patches be cut to obtain the right dose?

A

No - risk of overdose

142
Q

Why do patients need to avoid heat exposure when using fentanyl patches?

A

Heat increases the absorption of fentanyl

143
Q

When switching fentanyl patches, should patients

a) take off the old one then apply the new one
b) apply the new one then take off the old one

A

a

144
Q

Should fentanyl patches be used in opioid naive patients?

A

No - risk of respiratory depression

145
Q

Which antibiotic interact with fentanyl?

A

Clarithromycin
It increases the exposure to fentanyl
Adjust the fentanyl dose and monitor

146
Q

Why may IV fentanyl need to be co-prescribed with a benzodiazepine or smooth muscle relaxant?

A

IV fentanyl can cause muscle rigidity when the dose is high

147
Q

How frequently should fentanyl patches be changed?

A

Every 72 hours

148
Q

How long may it take for fentanyl patches to work?

A

24-72 hours

149
Q

What symptoms of overdose should patients be aware of when using fentanyl?

A 
Breathing difficulties 
Extreme drowsiness
Slurred speech
Confusion
Dizziness
150
Q

Can patients with diabetes take buccal fentanyl tablets?

A

Yes

But they should be aware that each tablet contains 2g of glucose

151
Q

How is morphine switched to fentanyl patches?

A

Start fentanyl patch

Continue morphine for 12 hours to ensure that the patient isn’t in pain

152
Q

How are fentanyl patches switched to morphine?

A

Stop the fentanyl
Start the morphine at a low dose
Because it takes 17 hours for the fentanyl to reduce by 50%

153
Q

How long can a women breastfeed after using fentanyl patches?

A

72 hours

154
Q

How long can a women breastfeed after using fentanyl buccal tablets?

A

5 days

155
Q

What schedhle is fentanyl?

A

Schedule 2 CD

156
Q

List some brands of fentanyl

A 
Matrifen
Yamex 
Durogesic DTrans
Genito
Mezolar 
Victanyl
157
Q

Which opioid can only be partially reversed by naloxone?

A

Buprenorphine

158
Q

How many buprenorphine patches can be used at a time?

A

2

But these should be applied in different places

159
Q

How does buprenorphine interact with other opioids?

A

It increases the risk of opiate withdrawal

160
Q

What needs to be monitored when on buprenorphine therapy?

A

Liver function

Viral hepatitis status should be determined before commencing treatment

161
Q

When using a 7 day buprenorphine patch, how long should you not apply a different patch to the same area for?

A

3 weeks

162
Q

When using a 24 or 72 hour buprenorphine patch, how long should you not apply a different patch to the same area for?

A

7 days

163
Q

After taking a buprenorphine sublingual tablet, how long shouldn’t patients eat or drink for?

A

5 minutes

164
Q

Are Esperanto and buprenorphine oral lysophillates interchangeable?

A

No

165
Q

How do you switch from methadone to buprenorphine?

A

Reduce methadone to max 30mg daily

If methadone dose is above 10mg, start buprenorphine 4g

If methadone dose is below 10mg, start buprenorphine 2mg

166
Q

How many days do Butec, BuTrans and Reletrans patches need to be replaced?

A

Every 7 days

167
Q

What classification is buprenorphine?

A

Schedule 3 CD

168
Q

What are the features of a migraine?

A 
Severe
Pulsating
Unilateral 
Precipitated by physical activity 
May be nausea, vomiting, photophobia, photophonia
169
Q

What are the two main types of migraine?

A

Migraine with aura
Migraine without aura

Episodic
Chronic

170
Q

What is the difference between an episodic and a chronic migraine?

A

Episodic - a headache that occurs on less than 15 days per month

Chronic - a headache that occurs on more than 15 days per month
And has the characteristics of a migraine on at least 8 of these days

171
Q

What type of drugs are triptans?

A

5HT1-receptor agonists

172
Q

How should triptans be taken for migraine?

A

Take one tablet as soon as the headache starts

If this helps but the migraine comes back, you can take another tablet after 2 hours

173
Q

Which NSAID is first line for migraine?

A

Ibuprofen

174
Q

When can mefanamic acid be used in migraine?

A

For menstrual migraines if the woman is already using it for other indications such as dysmenorrhea or menorrhagia

175
Q

If monotherapy is inadequate for migraines, what’s the next step?

A

Combined therapy with a triptan and an NSAID

176
Q

If sumatriptan is inadequate for migraine, what do you use next?

A

Another triptan

177
Q

Which antiemetics are used in nausea and vomiting associated with migraine?

A

Metoclopramide

Prochlorperazine

178
Q

What options are there for migraine prophylaxis?

A

First line - propranolol
Alternative beta-blockers - atenolol, metoprolol, bisoprolol

Topiramate

Amitriptyline

179
Q

How long should a drug for migraine prophylaxis be tried for?

A

3 months

180
Q

What is considered a good response to migraine prophylaxis?

A

A 50% reduction in migraines

181
Q

What drugs can be used for menstual migraine prophylaxis, and when is it used?

A

Frovatriptan

Start 2 days before menstruation starts, stop 3 days after menstruation starts

182
Q

Which triptans are used in cluster headaches?

A

Sumatriptan, zolmitriptan

183
Q

Can a patient with diabetes take a triptan?

A

Yes

But triptans are cautioned in patients with CVD risk factors, including diabetes

184
Q

Why are triptans contraindicated in cardiovascular disease?

A

They cause vasoconstriction

185
Q

Why are triptans unlicensed in the elderly?

A

They cause vasoconstriction

186
Q

What are the side effects of triptans?

A

Nausea, vomiting
Flushing, feeling of heat/cold
Dizziness, drowsiness
Dyspnoea

187
Q

If a person taking a triptan experiences chest tightness, what should be done?

A

Discontinue the triptan

This could be due to vasoconstriction

188
Q

When medications interact with triptans?

A

MAOI

Drugs that cause serotonin syndrome e.g. SSRI, tramadol, ondansetron, methadone, lithium, buspirone, tapentadol

189
Q

Which triptan interacts with propranolol which may require a dose reduction?

A

Rizatriltan
Maximum dose 5mg if the patient is taking propranolol
Take two hours apart

190
Q

Can people use triptans if they are pregnant or breastfeeding?

A

Pregnant - only if benefit outweighs risk

Breastfeeding - don’t breastfeed for 12 hours after taking a triptan

191
Q

What medications are used for the prophylaxis and treatment of cluster headaches?

A

Prophylaxis - verapamil, lithium

Treatment - sumatriptan injection, or sumatriptan or zolmitriptan nasal spray

192
Q

What drugs are usually used to manage neuropathic pain?

A

Amitriptyline
Nortriptyline
Pregabalin
Gabapentin

193
Q

Do oral medications for neuropathic pain usually work straight away?

A

No, they usually take 4-6 weeks to work

194
Q

Is tramadol usually used in neuropathic pain?

A

No

It should only be used when other treatments have been unsuccessful, whilst on the waiting list to see a specialist

195
Q

What drug is usually used for trigeminal neuralgia?

A

Carbamazepine

196
Q

Why might corticosteroids be useful in neuropathic pain?

A

They reduce inflammation and swelling, which may take some pressure off of nerves

197
Q

List some side effects of amitriptyline

A

Sedation
Anticholinergic side effects
QT interval prolongation, cardiac arrhythmias, severe hypotension
Reduced seizure threshold

198
Q

What drugs interact with gabapentin and pregabalin?

A

Alcohol and opioids - risk of respiratory depression

Indigestion remedies - leave a 2 hour gap

199
Q

What are the maximum doses of pregabalin and gabapentin in neuropathic pain?

A

Gabapentin - 3.2g

Pregabalin - 600mg

200
Q

What important safety information is associated with gabapentin and pregabalin?

A

Risk of respiratory depression
Risk of abuse
Risk of suicidal thoughts and behaviours

201
Q

Why aren’t capsaicin patches usually used?

A

They are very expensive (£200 per patch)

202
Q

How often is capsaicin cream usually applied?

A

3-4 times a day

Minimum dosage interval 4 hours

203
Q

What side effects limits the use of capsaicin?

A

Burning
Avoid having a hot shower or bath before applying the cream as this can make it worse
Don’t use under bandages
Was hands after administration

204
Q

How should capsaicin be handled?

A

Cream - wash hands immediately after use
Or what hands 30mins after it has been applied

Patch - use nitrile gloves

Pharmacy Pre-Reg 2020/2021 (18 decks)

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