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CNS November 23 > CNS Part 7 November 23 > Flashcards

CNS Part 7 November 23 Flashcards

1
Q

Blank

A

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2
Q

How long must someone be in pain for, for it to be chronic?

A

> 12 weeks

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3
Q

What is a common comorbidity associated with chronic pain?

A

Depression

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4
Q

What drugs are used for the management of pain?

A
  1. NSAID’s aspirin,
  2. paracetamol for MSK pain -
  3. Opioids for moderate to severe pain -
  4. Pregabalin and gabapentin for neuropathic pain -
  5. Benzodiazepines
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5
Q

Which opioids are strong, and which are weak?

A
  • STRONG Opioids:
    1. - Morphine,
    2. Oxycodone,
    3. Diamorphine,
    4. Fentanyl,
    5. Buprenorphine -

**WEAK Opioids: **
1. Tramadol,
2. Codeine,
3. Dihydrocodeine,
4. low dose Morphine

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6
Q

What type of pain are NSAIDs used in and what other condition?

A
  1. Chronic disease with pain and inflammation -
  2. Mild to moderate pain (MSK) -
  3. Dysmenorrhoea -
  4. Pain caused by secondary bone tumors -
  5. Postoperative analgesia
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7
Q

Which opioid should be avoided in patients with sickle cell?

A

Pethidine (causes seizures); all others are okay

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8
Q

What are the paracetamol doses in children?

A

Refer to a screenshot for specific doses

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9
Q

What are the ibuprofen doses in children?

A

Refer to a screenshot from slides for specific doses

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10
Q

What drugs are used for dental pain?

A
  1. NSAIDs (Ibuprofen, Aspirin, Diclofenac) -
  2. Paracetamol (temporarily) -
  3. Benzyldiazine mouthwash/spray -
  4. Diazepam (short-term only)
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11
Q

What drugs are used for pain associated with dysmenorrhea?

A
  1. Antiemetics for vomiting -
  2. Paracetamol and NSAIDs for pain -
  3. Contraceptives if due to ovulation
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12
Q

Which type of NSAID is better overall for the management of pain?

A

COX inhibitors (Coxibs) are better as they do not harm the GI tract

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13
Q

What type of pain are opioids used for?

A
  1. Mild to moderate pain -
  2. Moderate to severe pain, particularly visceral origin (e.g., heart)
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14
Q

When are opioids cautioned?

A
  1. Impaired respiratory function (avoid in COPD) -
  2. Asthma -
  3. Hypotension -
  4. Myasthenia gravis -
  5. Shock -
  6. Convulsive disorder
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15
Q

What are the common side effects of opioids?

A
    • Constipation -
  2. Euphoria -
  3. Drowsiness -
  4. Respiratory depression -
  5. Dilated pupils -
  6. Hypotension -
  7. Muscle rigidity -
  8. Dry mouth -
  9. Nausea and vomiting
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16
Q

What’s used to counteract the respiratory depression of opioids?

A

Naloxone (Narcan)

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17
Q

What are the main problems associated with opiates?

A
  • Respiratory depression -
  • Dependence and withdrawal -
  • Overdose
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18
Q

What long-term complications develop when taking opiates?

A
  • Hypogonadism - Adrenal insufficiency
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19
Q

Are opiates safe in pregnancy and breastfeeding?

A
  • Neonatal withdrawal and respiratory depression can occur in pregnancy - Breastfeeding is generally safe
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20
Q

What’s on the dispensing labels when taking opiates?

A

```Drowsiness ``
may affect driving or operating machinery”

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21
Q

What’s the maximum number of times patients can take morphine?

A
  1. Given every 4 hours;
  2. MR (Modified Release) formulations can be taken every 12 or 24 hours
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22
Q

What patient advice would you give regarding opioid patches?

A
  • -Apply to
  • dry, non-irritated,
  • non-hairy skin
  • on upper torso
  • or outer arm - Heat or fever can increase absorption,
  • so avoid heat and saunas -
  • Remove after the recommended duration -
  • Avoid using the same area for at least 3 weeks -
  • Remove if experiencing difficulties breathing, drowsiness, confusion, or dizziness
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23
Q

How do patients stop opiate treatment?

A
  • Never stop abruptly, especially in long-term users -
  • Requires a multidisciplinary team -
  • Use opioid substitution therapy (methadone or buprenorphine) -
  • Complete withdrawal can take weeks or months, and some patients may stay on therapy indefinitely
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24
Q

When must dose adjustments be made when taking opiates?

A
  1. Palliative care may require doses higher than licensed
  2. Adjustments based on changes in renal and liver function -
  3. Dose may need to be reduced if experiencing side effects -
  4. Short courses may be given if there’s a risk of abuse or suicide
25
Q

Which opiates have agonist and antagonist properties?

A

Buprenorphine

26
Q

How are breakthrough pain doses calculated when taking opiates?

A
  1. Minimum: 1/10th of the total daily dose -
  2. Maximum: 1/6th of the total daily dose
27
Q

Which buprenorphine patches are taken every 3, 4, and 7 days?

A
  • 3 days/72 hrs: Hapoctasin, Prenotrix -
  • 4 days/96 hrs: Bupeaze, Buplast, Transtec, Relevect -
  • 7 days: Butrans, Butec, Bupramyl, Reletrans, Sevodyne, Panitaz
28
Q

What opiate is used by patients every day for life to help come off opiates?

A

Methadone

29
Q

What is neuropathic pain, and what drugs are used to treat it?

A
  • Neuropathic pain is caused by damage to neural tissue and can include conditions like
  • diabetic neuropathy,
  • postherpetic neuralgia,
  • and peripheral neuropathies -

Drugs used for treatment include Amitriptyline, Nortriptyline, Pregabalin, Gabapentin, Tramadol, Lidocaine, and Capsaicin cream

30
Q

What drugs are used for treating migraines?

A
  1. Aspirin,
  2. Paracetamol (soluble) -
  3. 5HT1 receptor agonists (Triptans) -
  4. Antiemetics
31
Q

What can patients use if they use migraine pills excessively?

A

Overuse of migraine medication can lead to overuse headaches and exacerbation of symptoms (rebound effects).

32
Q

When must patients be referred for migraines with red flag symptoms?

A

Red flag symptoms that warrant immediate referral include
paralysis,
slurred speech,
high temperature,
seizures,
double vision,
rash, and more severe symptoms.

33
Q

In what type of migraines are anti-migraine meds avoided?

A

Anti-migraine medications should be avoided in
Hemiplegic migraine,
Basilar Migraine,
Ophthalmoplegic migraine.

34
Q

What ergot derivative is used for migraines, and why is its use limited?

A

Ergotamine tartrate is used,
but its use is limited due to absorption difficulties and potential side effects

N&V, abdominal pain, muscle cramps.

It should not be used prophylactically.

35
Q

When is migraine prophylaxis considered?

A

Migraine prophylaxis is considered when a patient experiences two or more attacks per month,

more frequent headaches, treatment for migraine attacks is not suitable, or migraines are disabling.

36
Q

What medicines are used in migraine prophylaxis?

A

Medications used in migraine prophylaxis include
1. beta-blockers (Propranolol, Atenolol, Metoprolol, Nadolol, Timolol),
2. TCAs,
3. Gabapentin,
4. Topiramate,
5. Sodium V, Pizotifen,
6. Botulinum toxin type A (for chronic migraines in adults).

37
Q

What drugs are used to treat cluster headaches?

A
  • Subcutaneous Sumatriptan is the first-line choice - Alternatively, nasal Sumatriptan or nasal Zolmitriptan can be used.
38
Q

When is cluster headache prophylaxis considered?

A

Cluster headache prophylaxis is considered when
* attacks are more frequent,
* lasting more than 3 weeks,
* or cannot be effectively treated.

39
Q

What is used for cluster headache prophylaxis?

A

Cluster headache prophylaxis can include
1. Verapamil,
2. lithium (unlicensed),
3. Prednisolone,
4. Ergotamine (both short-term).

40
Q

What’s used to help people quit smoking?

A

Smoking cessation methods include
1. NRT (Nicotine Replacement Therapy),
2. Bupropion,
3. Varenicline.

41
Q

What factors affect the choice of treatment for managing smoking cessation?

A

Factors include the patient’s preference for immediate or sustained relief from cravings,
with NRT available in various forms to accommodate different preferences.

42
Q

What are the main side effects of NRT?

A
  1. Oral spray may cause paresthesia -
  2. Patches can lead to abnormal dreams (removing before bed may help) -
  3. Lozenges and oral spray may cause rash and hot flushes -
  4. Patches and oral spray may lead to sweating and myalgia -
  5. Patches can also cause arthralgia (joint pain).
43
Q

What opioids are used in opioid substitution therapy?

A

Opioid substitution therapy commonly uses Buprenorphine and Methadone.

44
Q

What should you do if a patient misses their methadone for more than 3 days in a row?

A

Assess the risk of overdose due to the loss of tolerance and consider reducing the dose for these patients.

45
Q

What should you do if a patient misses their methadone for more than 5 days in a row?

A

An assessment of illicit drug use is recommended before restarting substitution therapy,
especially for patients taking Buprenorphine because of the risk of precipitated withdrawal.

46
Q

How long does it usually take for complete cessation of opiates?

A

Complete cessation of opiates usually takes around
* 4 weeks in a hospital setting
* and up to 12 weeks in the community.

47
Q

Which opioid is safer to use when using opioid substitution therapy and why?

A
  • **Buprenorphine is considered safer for opioid substitution
  • therapy
  • it is less sedating than methadone,
  • carries a lower risk of overdose,
  • has milder withdrawal symptoms,
  • making dose reduction easier.**
48
Q

What must be done if opioid substitution therapy is used in pregnancy?

A
  • Pregnant women already on methadone or buprenorphine for opioid substitution
  • Should generally maintain therapy
  • to avoid acute withdrawal, which can harm the fetus.
  • Buprenorphine is not licensed for use during pregnancy.
49
Q

What adjunctive and symptomatic therapy is normally used in opioid patients?

A
  1. Loperamide for diarrhea -
  2. Mebeverine for stomach cramps -
  3. Paracetamol and NSAIDs for muscle pains/headaches -
  4. Metoclopramide or prochlorperazine for N&V -
  5. Topical rubefacients for muscle pain associated with methadone withdrawal -
  6. Short courses of short-acting benzodiazepines or zopiclone for insomnia -
  7. Lofexidine to alleviate physical symptoms of opioid withdrawal -
  8. Naloxone for accidental overdose -
  9. Naltrexone to prevent relapse
50
Q

When someone has alcohol addiction, can they come off abruptly, and what happens if they do?

A
  1. Abrupt cessation of alcohol can lead to alcohol withdrawal symptoms,
  2. including seizures,
  3. delirium tremens,
  4. and even death.
51
Q

What drugs are used for the management of alcohol addiction?

A
  • Assisted alcohol withdrawal:
  • Long-acting benzodiazepines,
    1. - chlordiazepoxide,
    2. carbamazepine,
    3. clomethiazole,
    4. lorazepam
    • Alcohol dependence:
      **CBT (Cognitive Behavioral Therapy) **
      This is the first-line treatment,followed by medications such as

acamprosate,
oral naltrexone,
nalmefene
(for high-risk drinkers).

52
Q

What are the main problems associated with long-term alcohol dependence/addiction?

A
  1. high blood pressure,
  2. heart disease,
  3. stroke,
  4. liver disease,
  5. digestive problems.
53
Q

What is given in delirium tremens associated with abrupt alcohol withdrawal?

A

Delirium tremens is a medical emergency and is typically treated with
oral or parenteral lorazepam as a first-line medication.

Haloperidol may be used as an adjunct.

54
Q

What is used for Wernicke’s encephalopathy?

A

Treatment typically involves
1. parenteral thiamine
2. followed by oral thiamine.

55
Q

What blood results would you expect to see in someone abusing alcohol?

A
  1. Raised GGT (Gamma-Glutamyl Transferase) -
  2. Raised PEth
    (Phosphatidylethanol, a direct alcohol biomarker) -
  3. Raised blood alcohol results -
  4. Raised ethanol in breathalyzers
56
Q

What are paracetamol doses in Children 3months to 6 years

A

Infant syrup: 120mg/5ml
Dosage for infant syrup
(strength 120mg/5ml) showing by age how much to give and how often
Age How much? How often?

  • 3 to 5 months 2.5ml Max 4 times in 24 hours
  • 6 to 23 months 5ml Max 4 times in 24 hours
  • 2 to 4 years 7.5ml Max 4 times in 24 hours
  • 4 to 6 years 10 ml Max 4 times in 24 hours
57
Q

What is the paracetamol dose for children 6+

A

Six plus (6+) syrup: 250mg/5ml

Paracetamol 250mg/5ml syrup dosages for children by age,

how much to give and how often
Age How much? How often?

  • 6 to 8 years 5ml Max 4 times in 24 hours
  • 8 to 10 years 7.5ml Max 4 times in 24 hours
  • 10 to 12 years 10ml Max 4 times in 24 hours
58
Q

What are the Tablet Doses of Paracetamol for children 6+

A

Tablets
Paracetamol tablet dosages for children by age, how much to give and how often**

Age How much? How often?

  • 6 to 8 years 250mg Max 4 times in 24 hours
  • 8 to 10 years 375mg Max 4 times in 24 hours
  • 10 to 12 years 500mg Max 4 times in 24 hours
  • 12 to 16 years 750mg Max 4 times in 24 hours

CNS November 23 (7 decks)

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