Drugs: Pain + Nausea Flashcards

1
Q

SOCRATES Mnemonic for Pain

A
Site
Onset
Character
Radiation
Associated symptoms
Time/ duration
Exacerbating + relieving factors
Severity
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2
Q

1st line management for chronic neuropathic pain

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

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3
Q

1st line “rescue therapy” for acute exacerbations of neuropathic pain

A

Tramadol

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4
Q

1st line for Trigeminal neuralgia

A

Carbamazepine

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5
Q

Management for post-herpetic neuralgia

A

Localised pain: Topical capsaicin cream

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6
Q

Burning pain
Shooting pain
Numbness (pins and needles)
Not localised

A

Neuropathic pain

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7
Q

Sharp pain
Dull pain
Localised

A

Nociceptive pain (body responding to damage)

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8
Q

Paracetamol dosage for kids

A

15mg/kg in kids

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9
Q

Paracetamol is absorbed in the

A

proximal small bowel

- 20 to 60mins onset

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10
Q

Take paracetamol levels at

A

4 hours to allow maximum absorption

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11
Q

Time to effect of IV morphine

A

5 mins for 85%

15 mins for 100% effectiveness

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12
Q

10mg Oramorph lasts

A

4-6 hours

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13
Q

10mg MST lasts

A

12 hours

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14
Q

Anticipated medications for end of life

A

Morphine
Midazolam
Levomepromazine
Buscopan

No fluids (worsens resp secretions)

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15
Q

If pain is not controlled by morphine

A

increase dose by 30 - 50%

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16
Q

When switching Morphine > Oxycodone

A

divide by 2

17
Q

When switching oral Morphine > s/cut Morphine

A

divide by 2

18
Q

When switching oral Morphine > s/cut Diamorphine

A

divide by 3

19
Q

When switching oral Oxycodone > s/cut Diamorphine

A

divide by 1.5

20
Q

Breakthrough dose of morphine =

A

1/6th of daily morphine dose

21
Q

When switching Codeine > Morphine

A

divide by 10

22
Q

When switching Tramadol > Morphine

A

divide by 10

23
Q

Analgesia in renal impairment

A
  1. Fentanyl
  2. Buprenorphine
  3. Alfentanil

Excreted via liver

24
Q

Management of acute agitation

A
  1. Haloperidol
  2. Chlorpromazine
  3. Levomepromazine
25
Q

Management of terminal agitation

A

Midazolam

26
Q

Management of hiccups at end of life

A
  1. Chlorpromazine

2. Haloperidol

27
Q

Management of metastatic bone pain

A
  1. Analgesia
  2. Biphosphonates
  3. Radiotherapy
28
Q

Management of respiratory secretions at end of life

A

Hyoscine hydrobromide

29
Q

Management of bowel colic at end of life

A

Hyoscine butylbromide (buscopan)

30
Q

Management of oral/throat pain at end of life

A

Benzydamine hydrochloride

31
Q

Management of nausea + vomiting at end of life

A

Levomepromazine

- long acting (8 - 12 hours)

32
Q

Management of gastric nausea

A

Metoclopramide

  • D2 receptor antagonist
  • prokinetic (promotes peristalsis)
33
Q

Side effects of metoclopramide

A

Extra pyramidal side effects

34
Q

Management of extra-pyramidal side effects

A

Domperidone

35
Q

Management of nausea from chemotherapy

A

Ondansetron

  • Serotonin receptor antagonist
  • acts on medulla oblongata
36
Q

Side effects of ondansetron

A

“drys you up”

- constipation etc

37
Q

Management for nausea due to intra-cranial pathology

A
  1. Dexamethasone
    - reduces oedema around tumours
  2. Cyclizine (for vomiting)