N&V/Pain Management/Multiple Sclerosis Flashcards
Which Antihistamines are useful for prophylaxis and treatment of N&V?
Cyclizine and Promethazine
Which Phenothiazine is useful for prophylaxis and treatment of N&V
Prochlorperazine
What drug should be used for postoperative N&V?
Ondansetron (5HT3-receptor antagonist) or Dexamethasone
What drug should be used for preoperative anticipatory N&V?
Lorazepam
What drug should be used for Motion Sickeness?
Hyoscine Hydrobromide
What drug should be used for N&V in Terminal Illness/Palliative Care?
Antipsychotics:
Haloperidol and Levomepromazine
What drug should be used for N&V in patients with Parkinsons’ Disease and why ?
Domperidone - it does not cross blood brain barrier
What is the minimum age for Domperidone?
12yrs
What is the minimum weight for Domperidone?
35kg+
What is dangerous side effect that can occur with Domperidone?
QT Prolongation
What is the maximum dosage for Domperidone?
10mg TDS Max 7 days
What type of side effects does Metoclopramide cause making it unsuitable for Parkinsons Disease patients?
Extrapyramidal Side Effects
What is the minimum age for Metoclopramide?
18 yrs
What is the max dosage for Metoclopramide?
10mg TDS 5 days max
What drugs come under non-opiates used for mild pain?
Paracetamol, NSAIDs, Aspirin
Which Weak Opiates can be used for MIld-Molderate Pain and for how many days use?
Codeine, Dihydrocodeine
Max 3 days use
Which Opiate should be used for Moderate Pain?
Tramadol
What are 4 Side effects to be aware of with Tramadol?
Lowers seizure threshold
Serotonin Syndrome
Increased Risk of Bleed
Psychiatric Disorder
What Strong Opiates can be used to treat Moderate-Severe Pain?
Morphine, Oxycodone, Methadone, Buprenorphine, Fentanyl
What is the minimum age for codeine and why?
12 years - risk of respiratory side effects
(18yrs for codeine linctus)
Why should children under 18 who have had their tonsils removed not use codeine?
Risk of Sleep Apnoea
Why should codeine be avoided in Afro-Caribbean patients?
They are ultra-rapid metabolisers and therefore toxicity can occur
Is Codeine safe for breastfeeding patients?
No, Avoid in breastfeeding patients
What are common Opiate Side Effects caused by acting on the Muscuranic pathway?
Dry Mouth
Constipation
CNS Depression
N&V
Hypotension
Miosis (pupil constriction)
What can prolonged use of Strong Opiates cause?
Hypogonadsim
Adrenal Insufficiency
Hyperalgesia
What is used to treat an overdose of Strong Opiates?
Naloxone
Which conditions should strong opiates be avoided in?
Paralytic Ileus
Respiratory Disease
Head Injury
What fraction of the total daily dose of an opiate should the breakthrough pain be?
1/6th to 1/10th of total daily dose every 4hrs (max use = 6 times a day)
How much can you increase doses of opiates each day?
By 1/2 to 1/3
When switching between opiates how much should you reduce their dose by and why?
1/2 to 1/3 to prevent overdose
Why is Oxycodone chosen over morphine for patients who get nausea from opiates?
Oxycodone is more potent than morphine therefore it is stronger in smaller quantities.
What are the main counselling points for Opiate Patches?
Avoid exposure to heat, apply to dry hairless area, rotate site
Over what time period should gabapentin and pregabalin be withdrawn if a patient wants to stop?
Gradually over 1 week
Which Tricyclic Antidepressants can be used for Neuropathic pain?
Amitriptyline or Nortriptyline
What is Multiple Sclerosis?
A chronic autoimmune disease demyelinating the CNS
What is considered as active Multiple Sclerosis?
2 relapses in the past 2 years despite treatment with interferon beta
What drugs can be used to manage spasticity symptoms associated to Multiple Sclerosis?
Baclofen, Diazepam, Tizanidine and Dantrolene
What drug can be used to treat Multiple Sclerosis relapse?
Methylprednisolone
What drug can be used to treat Oscillopsia associated with Multiple Sclerosis?
Gabapentin
Which Opiates are used for neuropathic pain?
Tramadol, Morphine or Pregabalin
Which topical localised treatments can be used for neuropathic pain?
Lidocaine or Capsaicin
What can be used to treat mood alteration in patients with Multiple Sclerosis?
Amitriptyline
What can be used to treat fatigue associated with multiple sclerosis?
Amantadine or Fampridine
Why should doses of Baclofen be increased slowly?
It is associated with major side effects such as sedation and hypotonia (decreased muscle tone)
