N&V/Pain Management/Multiple Sclerosis

Question 1

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

Answer 1

Cyclizine and Promethazine

Question 2

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

Answer 2

Prochlorperazine

Question 3

What drug should be used for postoperative N&V?

Answer 3

Ondansetron (5HT3-receptor antagonist) or Dexamethasone

Question 4

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

Answer 4

Lorazepam

Question 5

What drug should be used for Motion Sickeness?

Answer 5

Hyoscine Hydrobromide

Question 6

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

Answer 6

Antipsychotics:
Haloperidol and Levomepromazine

Question 7

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

Answer 7

Domperidone - it does not cross blood brain barrier

Question 8

What is the minimum age for Domperidone?

Answer 8

12yrs

Question 9

What is the minimum weight for Domperidone?

Answer 9

35kg+

Question 10

What is dangerous side effect that can occur with Domperidone?

Answer 10

QT Prolongation

Question 11

What is the maximum dosage for Domperidone?

Answer 11

10mg TDS Max 7 days

Question 12

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

Answer 12

Extrapyramidal Side Effects

Question 13

What is the minimum age for Metoclopramide?

Answer 13

18 yrs

Question 14

What is the max dosage for Metoclopramide?

Answer 14

10mg TDS 5 days max

Question 15

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

Answer 15

Paracetamol, NSAIDs, Aspirin

Question 16

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

Answer 16

Codeine, Dihydrocodeine
Max 3 days use

Question 17

Which Opiate should be used for Moderate Pain?

Answer 17

Tramadol

Question 18

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

Answer 18

Lowers seizure threshold
Serotonin Syndrome
Increased Risk of Bleed
Psychiatric Disorder

Question 19

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

Answer 19

Morphine, Oxycodone, Methadone, Buprenorphine, Fentanyl

Question 20

What is the minimum age for codeine and why?

Answer 20

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

Question 21

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

Answer 21

Risk of Sleep Apnoea

Question 22

Why should codeine be avoided in Afro-Caribbean patients?

Answer 22

They are ultra-rapid metabolisers and therefore toxicity can occur

Question 23

Is Codeine safe for breastfeeding patients?

Answer 23

No, Avoid in breastfeeding patients

Question 24

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

Answer 24

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

Question 25

What can prolonged use of Strong Opiates cause?

Answer 25

Hypogonadsim Adrenal Insufficiency Hyperalgesia

Question 26

What is used to treat an overdose of Strong Opiates?

Answer 26

Naloxone

Question 27

Which conditions should strong opiates be avoided in?

Answer 27

Paralytic Ileus Respiratory Disease Head Injury

Question 28

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

Answer 28

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

Question 29

How much can you increase doses of opiates each day?

Answer 29

By 1/2 to 1/3

Question 30

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

Answer 30

1/2 to 1/3 to prevent overdose

Question 31

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

Answer 31

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

Question 32

What are the main counselling points for Opiate Patches?

Answer 32

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

Question 33

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

Answer 33

Gradually over 1 week

Question 34

Which Tricyclic Antidepressants can be used for Neuropathic pain?

Answer 34

Amitriptyline or Nortriptyline

Question 35

What is Multiple Sclerosis?

Answer 35

A chronic autoimmune disease demyelinating the CNS

Question 36

What is considered as active Multiple Sclerosis?

Answer 36

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

Question 37

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

Answer 37

Baclofen, Diazepam, Tizanidine and Dantrolene

Question 38

What drug can be used to treat Multiple Sclerosis relapse?

Answer 38

Methylprednisolone

Question 39

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

Answer 39

Gabapentin

Question 40

Which Opiates are used for neuropathic pain?

Answer 40

Tramadol, Morphine or Pregabalin

Question 41

Which topical localised treatments can be used for neuropathic pain?

Answer 41

Lidocaine or Capsaicin

Question 42

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

Answer 42

Amitriptyline

Question 43

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

Answer 43

Amantadine or Fampridine

Question 44

Why should doses of Baclofen be increased slowly?

Answer 44

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