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PAI > Clinical Analgesics > Flashcards

Clinical Analgesics Flashcards

1
Q

WHO analgesic ladder

A
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2
Q

Principles of WHO analgesic ladder

A

By the clock

By the mouth

By the ladder

Individual dose titration

Use adjuvant drugs

Attential to detail

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3
Q

Limitations of WHO ladder

A

Developed for cancer pain

Evidence base?

What are adjuvants?

When should adujants be introduced?

What is the purpose of step 2?

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4
Q

Paracetamol side effects

A

LARB

Rash

Blood disorders

Acute pancreatitis

Liver + renal damage following overdose

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5
Q

Paracetamol interactions

A

Warfarin

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6
Q

NSAID properties

A

Analgesic

Anti-pyretic

Anti-inflammatory

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7
Q

NSAID mechanism of action

A

Inhibit COX responsible for arachidonic acid metabolism to cyclic endoperoxides

  • Prevent formation of prostaglandins + thromboxanes
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8
Q

NSAID side effects

A

PGs involved in homeostasis + inflammation

GI Tract

  • GIT erosion + ulceration

Renal

  • reduce renal blood flow
  • sodium, potassium + H20 retention
  • acute liver failure

Respiratory

  • bronchospasm

Haematological

  • reduce platelet aggregation
  • Aspirin = irreversible
  • NSAIDs = reversible
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9
Q

Stratrgies to prevent GI side effects of NSAID

A

H2RAs

  • competitively inhibit H2 receptor sites on gastric parietal cells to regulate gastric pH

Misoprostol

  • synthetic prostaglandin E1 analogue

PPIs

  • inhibit acid secretion by binding irreversibly to proton pumps
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10
Q

COX-2 specific inhibitors (COXIBs)

  • Mechanism of action
  • Effectiveness
  • Side effects
A

Target PGs produced as result of pain + inflammation

e.g. celecoxib, etoricoxib, parecoxib

COXIBs are as effective as full dose NSAID comparators (but no better)

Side effects:

  • COXIBs reduce, but do not eliminate, GI adverse effects
  • Renal adverse effects are comparable with conventional NSAIDs
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11
Q

NSAID interactions

A

Increased bleeding

  • anti-coagulants
  • SSRIs
  • Corticosteroids

Renal impairment

  • Diuretics
  • ACEi

Reduce elimination

  • Lithium
  • Methotrexate (MTX)
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12
Q

1st choice NSAID for healthy young adults

A

Low dose ibuprofen (<1200mg/day)

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13
Q

What oral NSAID should be prescribed for pts with CV risk factors?

A

Low-dose ibuprofen or Naproxen 1000mg/day

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14
Q

What should be prescribed with any NSAID to pts with high GI risk + long-term NSAID users?

A

PPI

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15
Q

Topical NSAIDs

A

Don’t apply to broken skin, mucous membranes or near eyes

Wash hands after use

Not used in pregnant women

Not used with oral NSAIDs

Unlikely of any interactions due to low plasma levels achieved

Rubifacient onsidered in pts @ risk of oral NSAID side effects

Cheaper than topical

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16
Q

Types of opioid

A
17
Q

Name drugs for moderate pain + severe pain

A
18
Q

Constipation is a major proble for patients taking Opioids.

What treatment options are there for this?

A
19
Q

Patient controlled

  • ROA
  • Drug used
  • Advantages + Disadvantages
A
20
Q

What is epidural opioids?

A

Mixture of local anaesthetic + opioid

Commonly, fentanyl + bupivacaine

Respiratory depression uncommon due to lipophilicity of fentanyl

ADR = hypotension, infection + haematoma

21
Q

What are syringe drivers?

A

Continuous subcutaneous infusion

Used when:

  • patient cant take medicines by mouth
  • bowel obstruction
  • patient does not want to take regular oral medicines

Diamorphine is opioid of choice

22
Q

How is opioids monitored?

A

Pulse

BP

Respiration rate

Pain

Oxygen Saturation

Sedation score

Opioid usage

Opioid side effects

23
Q

What is Naloxone?

A

Opioid antagonist

Used to reverse effects of opioid especially when pts are experience severe respiratory depression

Higher affinity for opioid receptor than agonis

Short half life when given IV = repeat doses

Induce pain

Titrate gradually until effect is achieved

24
Q

What is tramadol?

A

MOR agonist

Inhibits neurotransmitter noradrenaline uptake + 5-HT release

Causes pronounced side effects e.g. nausea + hallucinations

Less pronounced opioid side effects e.g. constipation

25
Q

Tricyclic Antidepressants

A

Inhibit neuronal re-uptake of noradrenaline + serotonin

Use limited by ADR

ADR minimised by starting with low dose + small changes

Therapeutic dose 50 - 75 mg OD

e.g. amitriptyline + nortriptyline

26
Q

Antiepileptic drugs

A

e.g. carbamazepine, phenytoin + sodium valproate

  • Block voltage gated Na+ channels in peripheral neurones
  • High incidence of ADR
  • Limited license for neuropathic pain

e.g. gabapentin + pregabalin

  • prevents voltage dependent Ca2+ channel activation in dorsal horn neurones
  • No affect on sodium channels
  • Cause fewer side effects + interactions
  • licensed for neuropathic pain
27
Q

Capsaicin

A

Used for postherpetic neuralgia, osteoarthritis + diabetic neuropathy

Causes burning sensation

Counselling on application

  • pts need to wash hand after use before they start touching any sensitive part of their bodies e.g. eyes
28
Q

Lidocaine 5% medicated plaster

A

For PHN

Apply up to 3 plasters for 12 hrs each day

PAI (17 decks)

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