NON- Opiod Analgesics

Question 1

Paracetamol - What is the indication

Answer 1

indicated to be used as mild analgesia for pain relief , fever

Question 2

Paracetamol - What is the dose, A/e of paracetamol

Answer 2

Conventional route - 500mg-1 g every 4-6 hours ( Max 4 g )( Maximum of 8 tabs Daily)
Controlled release- 665-1.336g every 6-8 hours( Maximum of 6 tablets
Kids 15mg/kg every 4-6 hours
A/e- increased liver enzymes

Question 3

What are the practice and counselling points of paracetamol

Answer 3

paracetamol+ ibuprofen to treat fever is not recommended
Stick to one product that contain combination product
Pain relief occurs 30 minutes after administration

Question 4

Nsaids - what type of nsaids are available

Answer 4

non selective NSAIDS( COX1 and Cox 2 )
-Ibuprofen
-Aspirin
-Diclofenac
-Mefenamic acid
- Naproxen
- Piroxicam
- Indomethacin
Selective cox 2 inhibitors ( C/I in heart disease )
- celecoxib
- meloxicam
- Paracoxib

Question 5

What are the selection criteria for each type of NSAIDs

Answer 5

selective cox2 - are more GI protective- How?
They are not associated with inhibition of cox1 prostogladatins that are responsible for mucus lining at the stomach for protection against acid
- for pt with stomach problems

Question 6

What are the indications for NSAIDS

Answer 6

inflammatory condition
- postoperative pain
- migraine
- headache
- Rheumatoid arthritis
- gout
- osteo arthritis
- primary dysmenorrhea
menorrhea

Question 7

What are the precautions for NSAIDS -

Answer 7

Dehydration -NSAIDS reduce renal function as prostagladitins are important in maintain renal flow - causing increase risk of dehydration

Coagulation disorders( dvt, haemophillia) do to antiplatelet effect of Nsaids can increase bleeding

Asthma- can cause bronchospam

Cardiovascular events- avoid use in patients who have had MI or Stroke as Nsaids can increase risk of death 5 years post. Contraindicated in patients with sever heart failure
Can make heart failure or hypertension worse due to sodium retention and water retention due to nsaid induced reduction in glomerular filtration and reduced renal flow

Gastrointestinal- active peptic ulcer disease- CONTRAINDICATED if pt has active peptic ulcer or gi bleeding
Use with caution in pt who have IBD

Hypersensitivity reaction - ( asthma or angioedema) avoid use of any NSAID and seek specialist advice

Renal impairment- Can make existing renal impairment worse due to nsaid induced impairment
Avoid use if cr/cl is <25ml/min and <30ml/min in celecoxib

Surgery
-risk of renal impairment if dehydration or renal hypoperfusion exists
Make sure patient is hydrated preop if nsaid are to be used post opp

elderly - use with caution have increased risk of adverse effects- HF, renal impairment,

Pregnancy/breastfeeding-
Pregnancy -not indicated associated with miscarriage ,can cause neonatal renal failure

Breastfeeding, non selective inhibitors are safe - ibuprofen is preferred

Question 8

What are the adverse effects of NSAIDS

Answer 8

Common- nausea, dyspepsia, gi bleeding, peptic ulcer , diarrhoea, salt and fluid retention, hypertension

Infrequent - oesophageal ulcer, hyperkalaemia( K+), bronchospasm

rare- hypersensitivity reaction ( asthma, angioedema

Question 9

when to refer a patient taking NSAIDS

Answer 9

If patient develops
- swollen ankles
- heaviness in breathing
- chest pain
- coffee coloured vomit
- darken stools

Question 10

What are the comparative information In regards to NSAIDS

Answer 10

• Naproxen longest half life
• Ibuprofen- not to be used for babies with fever as they may only need fluids due to dehydration

Do not stop low dose asprin when taking nsaid - antiplatelet effect negligible

• Both cox 1 and cox 2 can worsen asthma and cardiovascular disease and renal function - avoid use or use with caution

PARACOXIB+AND ASPRIN DO NOT TAKE IF PATIENT HAS SULFASALAZINE SULFONAMIDES

Question 11

What is the dose of each NSAID

Answer 11

diclofenac 75-150mg in 2-3 doses (25mg 3 tabs or 50 mg tds)- MAX 200mg

ibuprofen- 200mg-400mg 3-4 times a day (2400mg d)

Indomethacin 925mg-50mg 3-4 times a day
- not to be used in kids less than 2
- can impact mental alertness

celecoxib-Contraindicated in heart disease( heart failure, angina, )-
- <200mg tab
- pain- 400mg single dose and then 200-400mg 1-2 daily for MAX 5 days

naproxen- 250mg-500mg bd
CR-750mg-1000mg OD
-Maximum of 1250mg
Period pain 500mg at initials, 250mg every 6-8 hrs

Mefenamic acid- 500mg tds

Meloxicam 7.5-15mg ONCE DAILY

Question 12

What are the counselling/Practice points of nsaids

Answer 12

-MAKE SURE TO DRINK WATER TO PREVENT DEHYDRATION AS IT CAUSE DECREASE RENAL FUNCTION GLOMERULUS Filtration
-in patients high risk of gi give ppi short term

Question 13

What medications care used to treat chronic pain

Question 14

Asprin