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Central Nervous System > N&V/Pain Management/Multiple Sclerosis > Flashcards

N&V/Pain Management/Multiple Sclerosis Flashcards

1
Q

Which Antihistamines are useful for prophylaxis and treatment of N&V?

A

Cyclizine and Promethazine

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2
Q

Which Phenothiazine is useful for prophylaxis and treatment of N&V

A

Prochlorperazine

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3
Q

What drug should be used for postoperative N&V?

A

Ondansetron (5HT3-receptor antagonist) or Dexamethasone

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4
Q

What drug should be used for preoperative anticipatory N&V?

A

Lorazepam

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5
Q

What drug should be used for Motion Sickeness?

A

Hyoscine Hydrobromide

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6
Q

What drug should be used for N&V in Terminal Illness/Palliative Care?

A

Antipsychotics:
Haloperidol and Levomepromazine

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7
Q

What drug should be used for N&V in patients with Parkinsons’ Disease and why ?

A

Domperidone - it does not cross blood brain barrier

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8
Q

What is the minimum age for Domperidone?

A

12yrs

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9
Q

What is the minimum weight for Domperidone?

A

35kg+

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10
Q

What is dangerous side effect that can occur with Domperidone?

A

QT Prolongation

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11
Q

What is the maximum dosage for Domperidone?

A

10mg TDS Max 7 days

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12
Q

What type of side effects does Metoclopramide cause making it unsuitable for Parkinsons Disease patients?

A

Extrapyramidal Side Effects

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13
Q

What is the minimum age for Metoclopramide?

A

18 yrs

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14
Q

What is the max dosage for Metoclopramide?

A

10mg TDS 5 days max

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15
Q

What drugs come under non-opiates used for mild pain?

A

Paracetamol, NSAIDs, Aspirin

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16
Q

Which Weak Opiates can be used for MIld-Molderate Pain and for how many days use?

A

Codeine, Dihydrocodeine
Max 3 days use

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17
Q

Which Opiate should be used for Moderate Pain?

A

Tramadol

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18
Q

What are 4 Side effects to be aware of with Tramadol?

A

Lowers seizure threshold
Serotonin Syndrome
Increased Risk of Bleed
Psychiatric Disorder

19
Q

What Strong Opiates can be used to treat Moderate-Severe Pain?

A

Morphine, Oxycodone, Methadone, Buprenorphine, Fentanyl

20
Q

What is the minimum age for codeine and why?

A

12 years - risk of respiratory side effects
(18yrs for codeine linctus)

21
Q

Why should children under 18 who have had their tonsils removed not use codeine?

A

Risk of Sleep Apnoea

22
Q

Why should codeine be avoided in Afro-Caribbean patients?

A

They are ultra-rapid metabolisers and therefore toxicity can occur

23
Q

Is Codeine safe for breastfeeding patients?

A

No, Avoid in breastfeeding patients

24
Q

What are common Opiate Side Effects caused by acting on the Muscuranic pathway?

A

Dry Mouth
Constipation
CNS Depression
N&V
Hypotension
Miosis (pupil constriction)

25
Q

What can prolonged use of Strong Opiates cause?

A

Hypogonadsim
Adrenal Insufficiency
Hyperalgesia

26
Q

What is used to treat an overdose of Strong Opiates?

A

Naloxone

27
Q

Which conditions should strong opiates be avoided in?

A

Paralytic Ileus
Respiratory Disease
Head Injury

28
Q

What fraction of the total daily dose of an opiate should the breakthrough pain be?

A

1/6th to 1/10th of total daily dose every 4hrs (max use = 6 times a day)

29
Q

How much can you increase doses of opiates each day?

A

By 1/2 to 1/3

30
Q

When switching between opiates how much should you reduce their dose by and why?

A

1/2 to 1/3 to prevent overdose

31
Q

Why is Oxycodone chosen over morphine for patients who get nausea from opiates?

A

Oxycodone is more potent than morphine therefore it is stronger in smaller quantities.

32
Q

What are the main counselling points for Opiate Patches?

A

Avoid exposure to heat, apply to dry hairless area, rotate site

33
Q

Over what time period should gabapentin and pregabalin be withdrawn if a patient wants to stop?

A

Gradually over 1 week

34
Q

Which Tricyclic Antidepressants can be used for Neuropathic pain?

A

Amitriptyline or Nortriptyline

35
Q

What is Multiple Sclerosis?

A

A chronic autoimmune disease demyelinating the CNS

36
Q

What is considered as active Multiple Sclerosis?

A

2 relapses in the past 2 years despite treatment with interferon beta

37
Q

What drugs can be used to manage spasticity symptoms associated to Multiple Sclerosis?

A

Baclofen, Diazepam, Tizanidine and Dantrolene

38
Q

What drug can be used to treat Multiple Sclerosis relapse?

A

Methylprednisolone

39
Q

What drug can be used to treat Oscillopsia associated with Multiple Sclerosis?

A

Gabapentin

40
Q

Which Opiates are used for neuropathic pain?

A

Tramadol, Morphine or Pregabalin

41
Q

Which topical localised treatments can be used for neuropathic pain?

A

Lidocaine or Capsaicin

42
Q

What can be used to treat mood alteration in patients with Multiple Sclerosis?

A

Amitriptyline

43
Q

What can be used to treat fatigue associated with multiple sclerosis?

A

Amantadine or Fampridine

44
Q

Why should doses of Baclofen be increased slowly?

A

It is associated with major side effects such as sedation and hypotonia (decreased muscle tone)

Central Nervous System (8 decks)

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