intro to analgesia and pain contro (inc children) Flashcards
types of pain
acute
chronic
cause of pain
inflammatory
neuropathic
vascualr
removal of pain peripherally
remove cause
antiinflammatoy and pain killers
LA
pain managment methods (alternative pain managments)
remove the cause medication regional anesthesia nerve blocks physcical methods (physiotherapy, manipulation, acupuncture) pyscolgoical (Relaxation, hypnosis)
trauma leads to
- release of phospholipase A2
- causes phospholipids to form arachidonic acid
- this can set off pathway of production, resulting in inflammatory mediator substances
what do sterioids do
block inflammatory pain
prevent arachnoic acid pathway
other alternatives to steroids
NSAIDS
what do NSAIDS
inhibit production of prostaglandins therefore reducing pain swelling and inflammtion
what does the other pathway in pain (not prostaglandin priduction) produce
5- lipoxygerase eventurally leading to cytokines interlukins, TNF a ect
what can blocking inflamamtion do (- side effects)
inflammation
- bronchoconstriction
- airway obstruction
- cell infiltration
what do prostaglandins do
- increase vascular permeability (swelling)
- inflammation
- contract smooth muscle
- increased hyperalgesia in sensory afferent nerve fibres
- reduce gastric acidiy
- inhibit platelet adhesion (clotting)
what does COX do (cyclo-oxygenases)
Catalyse the conversion of arachnidonic acid to biologically active prostaglandins (pain and inflammation) by cyclooxygenases and peroxidase activity
active prostaglandins physiological function
- protection of the GIT tract
- renal homeostasis (kidney)
- uterine function
- embryo implantation and labour
- regulation of the sleep wake cycle and body temperature
COx 1, where its found and what it does
Found in most tissues
- particularly in platelets, stomach and kidney
Responsible for
- production of prostaglandins
- important for responses to circulating hormones
- maintenance of gastric mucosal integrity and platelet function
- synthesises prostaglandins responsible for physiological funcitons including GIT protection
how to inhibit cox 1
classic NSAIDs
can also inhibit cox 2
results of inhibting cox 1
- inhibition reduces the ability of the stomach to protect itself from its acidic contents
- results in greater erosion and ulceration
when does cox 2 occur and what does it do
when you have an inflammatory repsonce
- responsible for the biosynthesis of some of the inflammatory prostaglandins
analgesics in DPF
- aspirin tablets dispersible
- diclofenac sodium tablets
- dihydrocodeine tablets 30mg
- ibuprofen tablets
- ibuprofen oral suspension sugar free
- paracetamol oral suspension
- paracetamol tablets
- paracetamol tablets soluble
NSAIDS in pregnancy
avoid
- risk of haemorrhage
- closure of ductus arterisus
- pulmonary hypertension of newborn
- delayed labour
- increased duration of labour
- increased blood loss in labour
prescribing drugs for children
Prescribe according to weight 1st month up to a year - 8th adult dose 1-5 years - quarter dose 6-12 - half dose
After 12 you are considered adult in doses
action of paracatamol
- Cox 1/2 ? maybe 3
- TRPA – 1 receptors ?
- Central actions?
dose of paracetamol
- 500mg-1g QDS /4-6 hourly
- no more than 4g in 24 hours
Under 50 kg - should only be having one tablet 500mg
Multiple preparations available - tablets
- capsules
- elixir (sugar free or sugar)
antidote for paracetamol
acetyl cystenine
20-30 is OD
overdose parecetamol symptoms
- nausea
- vomiting
- typically wont feel anything for 24 hours, but may be fatal
- refer to A/E asap
