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CPTP 4.21-23 > CPTP 4.21-23 > Flashcards

CPTP 4.21-23 Flashcards

1
Q

e.g. of step 2 WHO analgesic ladder drugs

A

codeine, tramadol

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2
Q

new adaptation of analgesic ladder

A

encourages bidirectional application, can start at top in some cases. adds a 4th step - nerve blocks, epidurals,

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3
Q

COX 1 function

A

gastroprotection, dilates afferent renal arterioles, makes thromboxane - platelet aggregation

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4
Q

COX 2 function

A

induced by pain and inflammation

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5
Q

What kind of asthmatic are NSAIDs contraindicated in

A

aspirin sensitive (can make them wheezy)

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6
Q

pharmodynamics of codeine

A

converted to morphine in liver and acts on mew receptors

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7
Q

why is codeine ineffective in some and toxic in others?

A

variable expression of enzymes in population, poor metabolisers (ineffective) and excess metabolisers (toxic). as metabolite = morphine?

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8
Q

what should you co-prescribe with codeine

A

laxatives

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9
Q

are tramadol’s effects reversed by naloxone

A

not totally

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10
Q

good opioid after bowel surgery

A

tramadol - not as constipating

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11
Q

tramadol mechanism of action

A

prevent serotonin and NE reuptake, NMDA antagonist,, ACh (nicotinic) antagonist.

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12
Q

opioid receptor - signal transduction?

A

g protein coupled

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13
Q

side effects of tramadol

A

serotonin syndrome, anticholinergic SEs, opiate side effects

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14
Q

types of morphine

A

MST - morphine sulphate tablets, zomorph (modified release), oramorph (liquid), sevredol (tablet form of immediate acting), diamorphine (IV), oxycodone, fentanyl

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15
Q

morphine mechanism of action

A

acts on µ-opioid receptors

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16
Q

analgesic ass with pruritus side effect

A

opiates

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17
Q

what do you prescribe for breakthrough pain when on morphine

A

PRN morphine - 1/6-1/10 total regular dose in 24h

18
Q

timing of morphine doses?

A

either immediate release 4hrly or modified release 12 hrly

19
Q

e.g. of immediate release morphine

A

oramoph, sevredol tablets

20
Q

MR morphine?

A

zomorph

21
Q

opioid by patch?

A

fentanyl, buprenorphine

22
Q

early sign of opiate toxicity

A

myoclonic jerks

23
Q

other signs of opiate toxicity

A

pin point pupils, hallucinations, confusion, reduced RR

24
Q

reason for opiate toxicity in 90% cases?

A

AKI

25
Q

adjuvant in muscle spasm/cramp

A

baclofen

26
Q

adjuvant in bone pain (bone mets, breast cancer, myeloma)

A

bisphosphonates (pamidronate in myeloma)

27
Q

adjuvant in abdomen spasms

A

hyoscine butyl bromide

28
Q

administration route at the end of life

A

SC (injections and infusions)

29
Q

prescribing for pain at EOL if eGFR > 30

A

morphine

30
Q

prescribing for pain at EOL if eGFR <30

A

alfentanil (less renally excreted)

31
Q

prescribing for N&V at EOL if eGFR >30

A

cyclizine

32
Q

prescribing for N&V at EOL if eGFR<30

A

haloperidol

33
Q

agitation at end of life (prescription)

A

midazolam

34
Q

tx of secretions at EOL if GFR >30

A

hyoscine hydrobromide

35
Q

tx of secretions at EOL if GFR <30

A

hyoscine butylbromide (buscopan)

36
Q

neuropathic pain mx options

A

TCAs (amitriptyline), SSRIs, Gabapentin (FIRST LINE), Pregabalin, ketamine (if all else fails), lidocaine

37
Q

rule on increasing morphine dose in 24h

A

shouldn’t increase by > 50%

38
Q

mx of opioid side effects

A

opioid rotation (tramadol, fentanyl patches), reduce dose and add adjuvant

39
Q

conversion of morphine oral to SC

A

/2

40
Q

breakthrough pain at the end of life

A

prescribe 1/6 of syringe driver dose SC

41
Q

What is the most appropriate opiate to use in renal failure via a syringe driver

A

Alfentanil (30 times more potent than oral morphine however)

CPTP 4.21-23 (1 decks)

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