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PRE-REG-Thuri > NERVOUS SYSTEM - PAIN MANAGEMENT > Flashcards

NERVOUS SYSTEM - PAIN MANAGEMENT Flashcards

1
Q

What is pain?

A

Unpleasant sensation in body

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2
Q

What are the 3 types of pain?

A
  1. Nociceptive
  2. neuropathic
  3. Nociplastic
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3
Q

What is an example of nociceptive pain?

A

Tissue damage

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4
Q

What is an example of neuropathic pain?

A

Nerve damage

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5
Q

What is an example of Nociplastic pain?

A

Sensation - change in pain pathway.
E.G. something that did not hurt before, can hurt now.

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6
Q

How many weeks of pain makes it chronic?

A

More than 12 weeks

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7
Q

What is cause of pain divided into?

A

Primary

Secondary

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8
Q

What is primary pain?

A

There is no cause of pain

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9
Q

What is secondary pain?

A

Pain caused by underlying condition.

e.g. cancer, neuropathic, surgery/trauma, headache

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10
Q

Describe pain ladder?

A

3 steps.

1- Mild pain (non opioids)

  1. Mild-mod pain (weak opioids)
  2. mod- severe pain (strong opiods)
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11
Q

Give 2 examples of non opioids for pain management?

A

paracetamol , NSAIDs (aspirin).

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12
Q

Give 3 examples of weak opioids for pain management?

A

Codeine, hydrocodeine, tramadol (moderate pain)

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13
Q

Give 5 examples of strong opioids for pain management?

A

Morphine, diamorphine, oxycodone, transdermal patches, buprenorphine, fentanyl

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14
Q

What 2 TCAs are used for neuropathic pain?

A

Amitriptyline

Nortiptyline

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15
Q

What 2 Anti-epileptic meds are used for neuropathic pain?

A

Gabapentin

Pregabalin

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16
Q

What is the risk of using pregabalin during pregnancy?

A

Can slightly increase risk of major congenital malformations.

Use effective contraception - avoid pregabalin use in pregnancy unless necessary.

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17
Q

What corticosteroid is used for treating nerve blocks?

A

Dexamethasone

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18
Q

What drug is used to help with bone metastases?

A

Bisphosphonates

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19
Q

What drug is used to treat muscle spasms?

A

Benzos

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20
Q

What schedule is codeine?

A

Schedule 5

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21
Q

What schedule is codeine via injection?

A

CD2

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22
Q

What schedule is tramadol

A

Drug schedule CD3

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23
Q

What schedule is diamorphine?

A

Schedule 2

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24
Q

What schedule is oral morphine <13mg/5ml?

A

Schedule CD5

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25
Q

Oxycodone drug schedule?

A

CD2

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26
Q

How is buphrenoprhine taken + what is schedule

A

sublingual

CD3

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27
Q

What is pethidine used for + schedule?

A

CD2 - used in labour

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28
Q

What does buildup of pethidine cause?

A

Convulsions

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29
Q

What schedule is tapentadol?

A

CD2- less N + V and constipation

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30
Q

What schedule is alfentanil + use?

A

CD2- used for intra operative analgesia

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31
Q

What is nefopam?

A

Non opiod

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32
Q

What schedule + opioid type is dihydrocodeine?

A

CD5- weak opioid

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33
Q

What is use of paracetamol?

A

Mild- moderate pain + fever - no anti-inflammatory effect

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34
Q

What is minimum age limit for codeine?

A

use in over 12 years old

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35
Q

Codeine is not recommended for adolescents (12-18) with what condition?

A

Breathing problems

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36
Q

What condition is codeine contra-indicated in all children (under 18 years) ?

A

For removal of tonsils or adenoids for the treatment of obstructive sleep apnoea

Can cause more breathing issues

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37
Q

Why is codeine avoided in ultra-rapid metabolisers?

A

Increase risk of toxicity

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38
Q

Should women breastfeeding take codeine?

A

No- codeine should not be used in breast-feeding mothers because it can pass to the baby through breast milk.

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39
Q

Why is codeine not allowed in use for under12 years?

A

Risk of respiratory SE

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40
Q

What are the 6 codeine SEs?

A

Dry mouth

constipation

CNS depression

Nausea + vomitting

hypotension

pupil constriction (mioisis)

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41
Q

What does codeine target?

A

mu opioid receptors

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42
Q

What is used as antidote for opioid overdose?

A

Naloxone

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43
Q

What does prolonged codeine/ opioid use cause? (3)

A

Hypogonadism

Adrenal insufficiency

hyperalgesia

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44
Q

What is hyperalgia?

A

Opioid overuse causing sensations to hurt more.

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45
Q

What 3 conditions should opioids be avoided in?

A

paralytic ileus

Head injury

respiratory disease

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46
Q

What is breakthrough pain?

A

1/6 to 1/10 of total dose every 2-4 hours

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47
Q

How to increase opioid doses per day?

A

Only increase by 1/2 or 1/3 a day

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48
Q

How to switch between opioids?

A

Reduce dose by 1/2 to 1/3 a day = prevent overdose

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49
Q

What is more potent; oxycodone or morphine?

A

Oxycodone - used in patients who cannot swallow large amounts of morphine

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50
Q

What 3 counselling points to tell patient using opioid patches?

A

Rotate sites

Avoid heat exposure

Apply to clean dry hairless skin

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51
Q

What to do if fentanyl patch toxicity suspected?

A

Remove ASAP

52
Q

What 2 drugs are used topically for neuropathic pain?

A

Lidocaine

Capsaicin

53
Q

What is paracetamol dose?

A

0-5 to 1g every 4-6 hrs PRN

54
Q

What is max paracetamol dose?

A

maximum 4g per day

55
Q

What 2 labels are on paracetamol box?

A

Do NOT take more than 2 at any 1 time. Do not take more than 8 in 24 hrs.

Contains paracetamol. Do not take anything else containing paracetamol whilst taking this med

56
Q

What can overdose of paracetamol cause?

A

Liver damage - higher risk in less than 50kg patients

57
Q

What is antidote for paracetamol overdose?

A

Acetylcysteine

58
Q

What is aspirin indication?

A

Mild- mod pain + fever

Anti-platelet - medical emergency + secondary prevention

59
Q

What is aspirin daily dose?

A

300 to 900 mg every 4-6 hrs

60
Q

What is maximum aspirin dose?

A

4g per day

2.4g without doctor’s advice

61
Q

What 2 labels are on aspirin box?

A

Do not take anything else containing aspirin while taking meds

Take with or just after food or meal - contains aspirin

62
Q

What are 2 SEs of apsirin?

A

GI irritation

Tinnitus

63
Q

What to give to avoid GI irritation with aspirin?

A

Give Enteric coated version

64
Q

What is minimum age for aspirin?

A

16

65
Q

Why cannot aspirin be given to under 16?

A

Can cause reyes syndrome

66
Q

What disease is exception to give aspirin to under 16 years?

A

In case of kawasaki disease or antiplatelet

67
Q

What are 4 signs of NSAID hypersensitivity?

A

Bronchospasm

Asthma attack

rhinitis

urticaria - hives/itching

68
Q

MOA of opioid analgesics?

A

Acts on opioid mew receptors in CNS

69
Q

What is indication of opioid analgesics?

A

Acute pain

Palliative care

Chronic malignant pain - short term

70
Q

What type of pain are opioids used short term for?

A

Chronic malignant pain

71
Q

What are 8 SEs of using opioids ?

A

1.Miosis (pinpoint pupils), muscle rigidity, mouth dry

  1. Out of it (sedation)
  2. RESPIRATORY DEPRESSION
  3. Postural hypotension
  4. Hyperalgesia, hallucination

6.Infrequency (urinary retention, constipation)

7.Nausea + vomiting

  1. Euporia
72
Q

What drug to treat vomiting caused by opioids?

A

Metoclopramide

73
Q

What is antidote for respiratory depression?

A

Naloxone

74
Q

What is a contraindication of opioids as one of the SE is pupil constriction?

A

not for patients with head injury - increased intracranial pressure

75
Q

What is a SE of opioids in high doses?

A

Hypotension

76
Q

What is a caution for opioids as they cause dependence?

A

May not be suited for patients with substance use, mental health disorder

77
Q

What is tolerance?

A

Higher doses are needed to reach same level of analgesia

78
Q

What is physical withdrawal?

A

Appears on abrupt withdrawal of opioids , physical symptoms show

79
Q

What is an MHRA warning related to addiction + dependence with prolonged use in non-malignant pain?

A

Withdrawal plan in place
regular monitoring needed.

Hyperalgesia if increased pain sensitivity
Give MHRA leaflet

80
Q

How to counsel patients on opioid use and reducing tolerance?

A

Report signs of overdose

81
Q

What are the 3 symptoms of opioid overdose?

A

Respiratory depression

Pinpoint pupils

coma

82
Q

What is a MHRA warning regarding benzodiazepines + opioids?

A

CNS depressant effects- monitor at start , if new dose + for any interactions

83
Q

When should methadone be monitored due to respiratory depression effect?

A

Methadone within 2 weeks of initiation

84
Q

What 2 laxative types are given to combat opioid use and constipation?

A

Osmotic + stimulant laxative

85
Q

What is a CI in using opioids due to constipation?

A

risk of paralytic ileus - caution in pts with IBD

86
Q

What to do if patient has hyperalgesia?

A

reduce opioid dose or switch

87
Q

What is hypogonadism?

A

Reduced fertility - no bleeding or ED

88
Q

What 4 main drug classes interact with opioids to cause CNS depression?

A

Alcohol*

Benzos*

Z drug*

Irreversible MAOIs*

Antihistamines, antipsychotics, barbiturates-

89
Q

What are 2 other indications of codeine?

A

Diarrhoea

Dry cough (18+)

90
Q

Codeine is used to treat —— in over 18s?

A

Dry cough

91
Q

What route is codeine NEVER given via?

A

IV - dangerous hypotensive effect

92
Q

What is maximum duration of treatment using codeine for moderate pain?

A

3 days

93
Q

What is maximum codeine dose in children aged 12-18?

A

Max daily dose of codeine should NOT pass 240 mg.

Taken up to four times a day at intervals of no less than 6 hours

94
Q

What is use of tramadol?

A

For mild to moderate pain

95
Q

What are 2 SEs of tramadol?

A

psychiatric reactions

Reduces seizure threshold

96
Q

What type of drugs interact with tramadol to increase serotonin syndrome?

A

Serotonergic drugs

97
Q

List common serotonergic drugs which can interact with tramadol to cause serotonin syndrome?

A

Antidepressants (SSRI, TCA, MAOIs), Lithium, methadone, MAO-B inhibitors, sumatriptan, ondansetron, st John’s wort

98
Q

What is morphine used for in palliative care aside from severe pain?

A

Dyspnoea in palliative care

99
Q

What is an alternative drug to oral morphine?

A

Oxycodone

100
Q

How often is immediate release oral morphine given?

A

4 hourly

101
Q

How often is MR oral morphine given?

A

12 or 24 hourly

102
Q

How is the dose of parenteral morphine compared to oral?

A

Parenteral dose is 1/2 of oral dose

103
Q

What are 2 SEs common in morphine?

A

N+ V

increased euphoria

104
Q

What is more potent; diamorphine or morphine?

A

Diamorphine - 2-3 times stronger

105
Q

Why is diamorphine better than morphine?

A

Less side effect of nausea + hypotension

106
Q

List parenteral strong opioid?

A

Diamorphine

107
Q

What is breakthrough pain dose?

A

1/6 to 1/10th of total daily dose every 2 to 4 hours

108
Q

What type of opioid preparation is used for breakthrough pain?

A

Immediate release

109
Q

How long is buprenorphine patches used for in pain management?

A

3 days, 4 days + 7 days

110
Q

Which drug is partially reversed by naloxone?

A

Buprenorphine

111
Q

What is 2 main SEs of Buprenorphine + Fentanyl?

A

withdrawal + respiratory depression

112
Q

What 3 counselling points apply to administration of Buprenorphine patches?

A
  1. avoid heat exposure (hot baths/saunas).
  2. apply to dry, non irritated, non hairy skin
  3. rotate patch site
113
Q

What are the common SE of Buprenorphine patches?

A

Appetite decreased (in adults); asthenia (in adults); dyspnoea (in adults); gastrointestinal discomfort (in adults); muscle weakness (in adults); oedema (in adults); sleep disorders (in adults)

114
Q

What duration is fentanyl patches commonly seen in?

A

72 hrs

115
Q

What is an MHRA warning for fentanyl patches regarding use in non cancer pain?

A

Do NOT use in opioid-naive patients - try other analgesics for non-malignant pain before this.

116
Q

How can we prevent fentanyl toxicity? (5 things)

A

not exceeding the prescribed dose

following the correct frequency of patch application, avoiding touching the adhesive side of patches, and washing hands after application

not cutting patches +avoiding exposure of patches to heat including via hot water;

ensuring that old patches are removed before applying a new one.

following instructions for safe storage and properly disposing of used patches or those which are not needed.

117
Q

Can we cut fentanyl patches?

A

NO

118
Q

When should a fentanyl patch be removed instantly?

A

When signs of breathing difficulties -drowsiness, confusion, dizziness, or impaired speech

119
Q

What is used for management of dysmenorrhoea?

A

Oral contraceptives

Paracetamol/NSAID if needed

120
Q

What is used to manage pain of mild sickle-cell crisis?

A

Paracetamol, NSAID, codeine or dihydrocodeine.

121
Q

Why to AVOID pethidine in sick cell management?

A

Can build up + toxic metabolite can increase risk of seizures.

122
Q

What has codeine linctus been reclassified as?

A

POM

123
Q

What is the ONLY use of codeine linctus?

A

dry cough, + only considered to be effective for chronic coughs lasting over 8 weeks

124
Q

What 3 cases are codeine CI in?

A

children younger than 12 years old

patients of any age known to be CYP2D6 ultra-rapid metabolisers

breastfeeding mothers

125
Q

Codeine effective in treating chronic coughs lasting over — weeks?

A

8 weeks

126
Q

What drug is given for Trigeminal neuralgia?

A

Anti epileptics - carbamazepine

127
Q

What cream is given as symptomatic relief for postherpetic neuralgia?

A

Capsaicin 0.075% cream is licensed for the symptomatic relief of postherpetic neuralgia.

PRE-REG-Thuri (44 decks)

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