CNS - PAIN Flashcards
1
Q
What is the most appropriate treatment for musculoskeletal pain?
A
- non-opioid drugs e.g. paracetamol and aspirin
- NSAIDs
2
Q
What is the most appropriate for dental treatment?
A
NSAIDs
3
Q
What is the most appropriate treatment for moderate to severe visceral pain?
A
opioids
4
Q
What is used for neuropathic pain?
A
- TCAs e.g. amitriptyline
- Antiepileptics e.g. gabapentin, pregablin
- for nerve compression by tumour - dexamethasone
5
Q
What are some examples of non-opioid analgesics?
A
- Aspirin - contra-indicated in under 16s
- paracetamol
- nefopam
- NSAIDs
6
Q
How do you treat paracetamol poisoning?
A
acetylcysteine
7
Q
Which non-opioid analgesic is preferred in the elderly?
A
paracetamol
8
Q
What are side effects of opioids in general?
A
pneumonic = MORPHINE
- Miosis - pinpoint pupils
- Out of it
- Resp depression
- Postural hypotension
- Hyperalgesia (more sensitive to pain)
- Infrequency
- N&v
- Euphoria
9
Q
Who are opioids contra-indicated in?
A
- comatose patients
- patients at risk of paralytic ileus
- resp depression
- head injury or raised intracranial pressure
10
Q
What interacts with opioids?
A
- 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
11
Q
Morphine:
A
- most euphoria, nausea, and vomiting
- alternative = oxycodone
12
Q
Diamorphine (heroin):
A
- parenteral route
- 1/3 dose of morphine
- less n&v
13
Q
Buprenorphine:
A
- Transdermal
- partial agonist
- effects partially reversed by naloxone
14
Q
Fentanyl:
A
- immediately remove if you have breathing difficulties - risk of resp depression
- transdermal route - avoid exposure to heat
15
Q
What codeine dose is appropriate for children between 12-18?
A
240mg for 3 days max
