OTC Pain Management in the Community Flashcards
1
Q
What are the main side effects of NSAIDs?
A
Gastric irritation
Bleeding
2
Q
What are the main cautions for NSAIDs?
A
- Asthma (may precipitate)
- Renal and hepatic disease
- Pregnancy (1st / 3rd trimesters)
3
Q
What are the contraindications for NSAIDs?
A
- Current/history of ulcers/gastric problems
- Aspirin in children under 16 (Reyes Syndrome)
4
Q
What main interactions exist for aspirin?
A
- Aspirin; warfarin and methotrexate
5
Q
What main interactions are present for ibuprofen?
A
- Ibuprofen; lithium and diuretics
6
Q
What drug classification does diclofenac potassium (Voltarol Tablets) belong to?
A
POM (MHRA alert 14 Jan 15)
7
Q
What is naproxen 250mg licensed to treat?
A
- Short term relief from dysmenorrhea (period pain) and menstrual cramps
8
Q
Who can take naproxen 250mg?
A
Only licensed for women 15 - 50 years
9
Q
Who can take paracetamol?
A
3 months >
10
Q
How long can it take for paracetamol toxicity to present?
A
A few days.
11
Q
What is the effect of caffeine + analgesic formulation?
A
Caffeine is not thought to have much effect; there is more caffeine in a cup of tea/coffee
12
Q
What is the indication for codeine/dihydrocodeine containing products?
A
Short term treatment of acute-moderate pain not relieved by paracetamol/ibuprofen/aspirin alone
13
Q
How many codeine-containing tablets are allowed until POM classification?
A
32.
14
Q
How long are topical NSAIDs recommended to be used for before GP referral?
A
Short-term use (
15
Q
What are the 4 things sought after in pain assessment?
A
- Location
- Duration
- Severity
- Recurrence
16
Q
What are the two common types of back pain?
A
- Soft tissue injury
- Back pain
17
Q
What is soft tissue injury and how is it characterised?
A
- Strain of spinal muscles and ligaments (e.g. lumbago; low back pain + fibromyalgia; widespread muscle pain/weakness) - usually from twisting or lifting
- Pain may spread across the back along the top of the pelvis/vertically on one side of the spine
- Pain may radiate to buttock or thigh, restricting movement and causing patient to adopt a posture leaning forward or to one side
18
Q
How quickly are acute soft tissue injuries resolved?
A
In 6 weeks.
19
Q
What does the trapping of root nerve in the back entail?
What is it charecterised by?
A
Usually sciatic nerve from slipped vertebral disc (sciatica)
- Felt in lower back and radiates down one leg, as far as foot
- Pain can be intense and burning
- Pain is constant and made WORSE by movement
- Patient limps and unable to flex the hip very far; making sitting and climbing stairs uncomfortable
- Gait is stiff and awkward
- Patients hold themselves rigid to avoid movement
20
Q
How is back pain treated?
A
- Analgesia
- Rest (particularly in sciatica) but NOT bed rest for simple back pain
- Heat e.g. heat pad/water bottle
21
Q
What lifestyle advice is recommended for back pain?
A
- Avoid bending or stooping, lifting or sitting on low chairs; allow time for back to recover
- Remain as active as possible
- On improvement/after 48 hrs, increase frequency of physical activity
- Stay at work or return to work A$AP
- Back pain rarely associated with serious illness
- Usually self-limiting
- Recovery usually a few days
22
Q
What red flags are associated with back pain?
A
- Backache not related to movement
- Upper back pain not obv. due to muscle or ligament strain
- Associated w/other symptoms of illness
- Associated w/neurological symptoms e.g. tingling or numbness in legs or feet
- Bowel or bladder function problems
- Severe pain at night
- Cyclical low-back pain in middle to second half of menstrual cycle
- Unresponsive to 7 day treatment with OTC products
23
Q
What is a sprain?
A
Sudden/violent twist of joint stretching or twisting ligaments w/possible rupture of blood vessels w/haemorrage to tissues
24
Q
What is a strain?
A
Muscular pain; caused by overuse, evidence of swelling.
25
What is a fracture?
Break in bone or cartilage
26
What is bruising?
Capillary damage; blue/purple in colour
| Result of blunt impact
27
What characterises acute injuries?
Often sport related:
- Sudden severe pain
- Swelling
- Renders limb or hand non-load bearing
- Extreme tenderness at site of injury
- Extreme weakness in leg or arm
- Bone or joint may be out of place
28
What characterises chronic injuries?
- Result of prolonged or repeated sport or exercise
- Pain during exercise
- Dull ache at rest
- Swelling
29
What are the red flags for injuries?
- Severe pain
- Severe swelling
- Numbness
- Limb unable to bear weight
- Limb, hand, foot of digit is immobolised
- Pain/ache in old injury
- Swelling occurs in old injury
- Joint feels abnormal or unstable
30
How are injuries treated?
- RICE
- Oral analgesics
- Topical analgesics/rubefacients
31
What is dental pain caused by? Why is it painful?
- Inflammation of pulp or peridontal membrane of tooth
- Rich nerve supply in both structures
- Impulse sent to cerebral cortex- pain perceived
32
Will dental pain just 'go away by itself'? Analgesics cure it?
- Not self-limiting; require REFERRAL
| - Analgesics give symptomatic relief until assessment/treatment available
33
What are the causes, signs and symptoms of toothache?
- Dental caries (decay)
- Dental abscess
- Pericoronitis
- Dry socket
- Gingival recession
34
What are the three main types of headache?
- Tension (most common)
- Vascular (e.g. migraine)
- Traction (inflammation/compression of brain REFER)
35
What is TTH and what are its origins?
- Tension-type headache
- Pericranial muscle contraction (the membrane covering the outer surface of the skull)
- Psychogenic origin
36
How is pain described in TTH?
- Often at base of skull but can be over top of head to eyes
- Bilateral (frontal/occipital)
- Dull pain, can be described as a band
37
How long do TTHs last and what are they triggered by?
- From a few hours to a few days
| - Triggered by tension, anxiety and fatigue
38
What is chronic daily headache and what characterises it?
- A type of tension headache; occurring at least 15 days of the month
- Lasts at least 4 hours per episode
- Seems to be present from morning to night
39
What is the pain like in chronic daily headache?
- Ache or dull throbbing pain
| - Simple/combination analgesia taken more than 3 days a week
40
What is a vascular headache?
- Dilatation or constriction of blood vessels in the brain and cranium
- Associated w/febrile (fever) illness; caused by vasodilatation
- Migraine is vascular in origin; neurochemical pathology also involved
41
What constitutes a migraine instead of a headache?
At least two of:
- Throbbing or pulsating pain
- Moderate to severe intensity pain
- Unilateral pain (one sided)
- Pain aggravated by movement
And at least one of:
- Nausea and/or vomiting
- Photophobia and phonophobia (sensitive to light/sound)
42
What can be an indication of an incoming migraine?
- Aura symptoms; perceptual disturbances e.g. strange light, unpleasant smell, confusing thoughts/experiences
43
What can migraines be triggered by?
- Menstrual cycle
- Certain foods
- Stress
44
What differs in the treatment for migraine to a simple headache?
- NSAIDs and Aspirin
- Paracetamol
- Compound analgesics
(above used in both)
- Sumatriptan (Imigran Recovery etc.)
- Prochlorperazine (Buccastem-M)
(used after above treatments tried)
45
What is the action of sumatriptan?
- Constricts cerebral arteries
| - Counteracts cranial vasodilatation
46
Who is sumatriptan licensed for OTC?
For acute migraine attack:
- 18 - 65 y/o
- with or w/o aura
47
What is the dose for sumatriptan?
- One tablet at onset
- Second dose may be taken after a minimum of two hours if migraine RECURS; second dose CANNOT be taken for same OG attack
- Max TWO in 24 hrs
48
What is sumatriptan's side effect profile?
Mild and transient
49
What contraindications are there for sumatriptan?
- SSRIs
- MAOIs (monoamine oxidase inhibitors)
- Moclobemide
- St John's Wort
- Other vasoconstrictor migraine treatment e.g. ergotamine (Migril), Methysergide (Deseril)
50
What conditions would restrict sumatriptan supply?
- Pregnant/breastfeeding
- CVD
- Hypertension
- Peripheral vascular disease
- Liver/kidney disorder
- Neurological conditions including epilepsy
51
When would you refer a patient taking sumatriptan?
- Attacks last longer than 24 hours
- Attacks become more frequent
- Symptoms change
- Patient has 4 or more attacks a month
- Patient does not completely recover between attacks
- Patient is over 50 years of age and having first migraine attack
52
What is a cluster headache and how is it characterised?
- Steady intense unilateral orbital boring pain
- Usually occurs same time each day
- Lasts 10 minutes to 3 hours
- REFER
53
Who do cluster headaches most often affect?
- Men in their 20s
| - 6:1 Male:Female ratio
54
What is a traction headache? Examples of causes?
Inflammation or compression of brain:
- Meningitis
- Encephalitis (inflammation often due to infection)
- Haematomas (localised collection of blood outside blood vessel)
- Tumours
- Cerebral abscesses (collection of pus/immune cells etc usually from BFI)
>>>>>REFER
55
What's the differential diagnosis of a traction headache?
- Eye strain (spasm/fatigue of ciliary and periorbital muscles of eye)
- Glaucoma
- Neuropathic pain from shingles
- Temporal arteritis (mostly OAPs); inflammation of arteries in/around scalp
- Referred pain from jaw
- Muscle strain and pulled ligaments in neck or upper bacl
56
What are the red flags for headache?
- Sudden onset 'first' headache
- Worst ever headache (may be subarachnoid haemorrage)
- Late onset new headache (>40 years)
- Headache w/stiff neck
- Headache w/stiff neck OR rash in under 12's
- Progressively increasing headache
- Headache w/drowsiness, unsteadiness, visual disturbances or vomiting
