CNS - PAIN Flashcards
What is the most appropriate treatment for musculoskeletal pain?
- non-opioid drugs e.g. paracetamol and aspirin
- NSAIDs
What is the most appropriate for dental treatment?
NSAIDs
What is the most appropriate treatment for moderate to severe visceral pain?
opioids
What is used for neuropathic pain?
- TCAs e.g. amitriptyline
- Antiepileptics e.g. gabapentin, pregablin
- for nerve compression by tumour - dexamethasone
What are some examples of non-opioid analgesics?
- Aspirin - contra-indicated in under 16s
- paracetamol
- nefopam
- NSAIDs
How do you treat paracetamol poisoning?
acetylcysteine
Which non-opioid analgesic is preferred in the elderly?
paracetamol
What are side effects of opioids in general?
pneumonic = MORPHINE
- Miosis - pinpoint pupils
- Out of it
- Resp depression
- Postural hypotension
- Hyperalgesia (more sensitive to pain)
- Infrequency
- N&v
- Euphoria
Who are opioids contra-indicated in?
- comatose patients
- patients at risk of paralytic ileus
- resp depression
- head injury or raised intracranial pressure
What interacts with opioids?
- alcohol - increased sedation
- tramadol - enhances anticoagulant effect of coumarins e.g. warfarin
- Rifampicin - decreased effect of fentanyl, morphine, codeine, methadone, alfentanil
- MAOIs - CNS excitation or depression
Morphine:
- most euphoria, nausea, and vomiting
- alternative = oxycodone
Diamorphine (heroin):
- parenteral route
- 1/3 dose of morphine
- less n&v
Buprenorphine:
- Transdermal
- partial agonist
- effects partially reversed by naloxone
Fentanyl:
- immediately remove if you have breathing difficulties - risk of resp depression
- transdermal route - avoid exposure to heat
What codeine dose is appropriate for children between 12-18?
240mg for 3 days max
Who is codeine contra-indicated in?
- under 12
- people known to rapidly metabolise codeine (morphine toxicity)
- children under 18 who undergo tonsilitis or sleep apnoea surgery
- children under 18 with respiratory problems
What are the side effects of tramadol?
- increased risk of bleeding
- lowers seizure threshold
- psychiatric reactions
What interacts with tramadol?
- drugs that lower seizure threshold
- drugs that increase serotonin levels
- drugs that increase bleeding risk
What are the guidelines from treating migraine?
- Simple analegesic (e.g. aspirin) or NSAID is often effective
- Concomitant antiemetic treatment may be required
- If that doesn’t work - 5HT1 receptor agonist ‘triptan’
- alternative = ergotamine = rarely used (CV side effects)
What drugs can be used for migraine prophylaxis?
- metoprolol, atenolol, propanolol, timolol
- antiepileptics
- TCAs, valproid acid
- pizotifen
How would you take the ‘triptans’?
One ASAP and second dose at least 2 hours later if migraine reoccurs
What are the contraindications for the triptans?
- CV problems
- Stop if intense tingling, heat, heaviness, pressure
