CNS - Pain Management

Question 1

Weak opioid examples?

Answer 1

Codeine, Dihydrocodeine

Question 2

Moderate opioid examples?

Answer 2

Tramadol

Question 3

Strong opioid examples?

Answer 3

Morphine
Oxycodone
Methadone
Buprenorphine
Fentanyl

Question 4

Tramadol side effects

Answer 4

• Serotonin Syndrome
• lowers seizure threshold
• increased risk of bleeding
• Psychiatric Disorders

Question 5

Codeine age restriction?

Answer 5

Over 12 years can use

Question 6

Can breastfeeding pt use codeine?

Answer 6

No! Avoid in breastfeeding

Question 7

Which other adult pt group should avoid codeine?

Answer 7

Ultra rapid metabolisers (Afro-carribean)
Causes toxicity!!!

Question 8

When can children over 12 but under 18 cannot use codeine?

Answer 8

Tonsils removed due to sleep apnoea

Question 9

Opiod side effects to look out for?

Answer 9

• Dry mouth
• Constipation
• CNS Depression
• Nausea and Vomiting
• Hypotension
• Miosis (Pupil constriction)

Question 10

Hyperalgesia meaning?

Answer 10

Opiod is Dependent by body

Small sensations cause bigger pain reaction

—-> higher Opiod amount needed than before

Question 11

Hypogonadism meaning?

Answer 11

Loss of function in gonads (testes/ovaries) - DO NOT PRODUCE ENOUGH SEX HORMONES

Question 12

Adrenal insufficiency defined by?

Answer 12

Adrenal glands not producing enough essential hormones (cortisol or aldosterone)

Question 13

Strong opioids can cause?

Answer 13

Hyperalgesia

Hypogonadism

Adrenal insufficiency

Question 14

Opiod overdose med?

Answer 14

Naloxone

Question 15

Who should avoid Naloxone?

Answer 15

Pt with:

Paralytic ileus
Respiratory disease
Head injury

Question 16

Breakthrough pain?

Answer 16

1/6 to 1/10th of tdd to be given every 2-4hrs prn

Max 12 times (every 2hrs)

Question 17

Increasing doses of opiates by?

Answer 17

Increase by 1/2 to 1/3 each day

Question 18

Reducing opiate dose when switching between opiates?

Answer 18

Reduce dose by 1/2 to 1/3

Eg)
Morphine 30mg -> Oxycodone 15mg

Question 19

Why pt are switched from morphine to oxycodone?

Answer 19

Oxycodone is more potent in smaller quantities

**Useful in pt who get nauseous when consuming large quantities

Question 20

Patches must do’s

Answer 20

Apply dry hairless area

Rotate sites

Avoid heat exposure

Question 21

Fentanyl what should you do if there’s signs of toxicity?

Answer 21

REMOVE PATCH IMMEDIATELY

Question 22

Neuropathic pain treated by?

Answer 22

• TCA
• Anti- epileptic
• Opiates
• Topical localised

Question 23

Which anti epileptic can treat neuropathic pain?

Answer 23

Pregabalin or Gabapentin

Question 24

Which TCA can treat neuropathic pain?

Answer 24

Amitriptyline or Nortriptyline

Question 25

Which opiates can treat neuropathic pain?

Answer 25

Tramadol, morphine or oxycodone

Question 26

Which localised topical med can treat neuropathic pain?

Answer 26

Lidocaine or Capsaicin

Question 27

Pregabalin in pregnancy, is it ok?

Answer 27

AVOID IN PREGNANCY- unless necessary Causes congenital malformations Pt should use effective contraception during treatment

Question 28

Pain relief in urinary tract disorders?

Answer 28

Tiaprofenic acid