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B32PAI - Clinical & Pharmacy Practice > OTC Pain Management in the Community > Flashcards

OTC Pain Management in the Community Flashcards

1
Q

What are the main side effects of NSAIDs?

A

Gastric irritation

Bleeding

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2
Q

What are the main cautions for NSAIDs?

A
  • Asthma (may precipitate)
  • Renal and hepatic disease
  • Pregnancy (1st / 3rd trimesters)
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3
Q

What are the contraindications for NSAIDs?

A
  • Current/history of ulcers/gastric problems

- Aspirin in children under 16 (Reyes Syndrome)

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4
Q

What main interactions exist for aspirin?

A
  • Aspirin; warfarin and methotrexate
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5
Q

What main interactions are present for ibuprofen?

A
  • Ibuprofen; lithium and diuretics
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6
Q

What drug classification does diclofenac potassium (Voltarol Tablets) belong to?

A

POM (MHRA alert 14 Jan 15)

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7
Q

What is naproxen 250mg licensed to treat?

A
  • Short term relief from dysmenorrhea (period pain) and menstrual cramps
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8
Q

Who can take naproxen 250mg?

A

Only licensed for women 15 - 50 years

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9
Q

Who can take paracetamol?

A

3 months >

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10
Q

How long can it take for paracetamol toxicity to present?

A

A few days.

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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

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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

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13
Q

How many codeine-containing tablets are allowed until POM classification?

A

32.

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14
Q

How long are topical NSAIDs recommended to be used for before GP referral?

A

Short-term use (

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15
Q

What are the 4 things sought after in pain assessment?

A
  • Location
  • Duration
  • Severity
  • Recurrence
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16
Q

What are the two common types of back pain?

A
  • Soft tissue injury

- Back pain

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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
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18
Q

How quickly are acute soft tissue injuries resolved?

A

In 6 weeks.

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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
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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
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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
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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
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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
Q

What is a fracture?

A

Break in bone or cartilage

26
Q

What is bruising?

A

Capillary damage; blue/purple in colour

Result of blunt impact

27
Q

What characterises acute injuries?

A

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
Q

What characterises chronic injuries?

A
  • Result of prolonged or repeated sport or exercise
  • Pain during exercise
  • Dull ache at rest
  • Swelling
29
Q

What are the red flags for injuries?

A
  • 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
Q

How are injuries treated?

A
  • RICE
  • Oral analgesics
  • Topical analgesics/rubefacients
31
Q

What is dental pain caused by? Why is it painful?

A
  • Inflammation of pulp or peridontal membrane of tooth
  • Rich nerve supply in both structures
  • Impulse sent to cerebral cortex- pain perceived
32
Q

Will dental pain just ‘go away by itself’? Analgesics cure it?

A
  • Not self-limiting; require REFERRAL

- Analgesics give symptomatic relief until assessment/treatment available

33
Q

What are the causes, signs and symptoms of toothache?

A
  • Dental caries (decay)
  • Dental abscess
  • Pericoronitis
  • Dry socket
  • Gingival recession
34
Q

What are the three main types of headache?

A
  • Tension (most common)
  • Vascular (e.g. migraine)
  • Traction (inflammation/compression of brain REFER)
35
Q

What is TTH and what are its origins?

A
  • Tension-type headache
  • Pericranial muscle contraction (the membrane covering the outer surface of the skull)
  • Psychogenic origin
36
Q

How is pain described in TTH?

A
  • 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
Q

How long do TTHs last and what are they triggered by?

A
  • From a few hours to a few days

- Triggered by tension, anxiety and fatigue

38
Q

What is chronic daily headache and what characterises it?

A
  • 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
Q

What is the pain like in chronic daily headache?

A
  • Ache or dull throbbing pain

- Simple/combination analgesia taken more than 3 days a week

40
Q

What is a vascular headache?

A
  • 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
Q

What constitutes a migraine instead of a headache?

A

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
Q

What can be an indication of an incoming migraine?

A
  • Aura symptoms; perceptual disturbances e.g. strange light, unpleasant smell, confusing thoughts/experiences
43
Q

What can migraines be triggered by?

A
  • Menstrual cycle
  • Certain foods
  • Stress
44
Q

What differs in the treatment for migraine to a simple headache?

A
  • NSAIDs and Aspirin
  • Paracetamol
  • Compound analgesics
    (above used in both)
  • Sumatriptan (Imigran Recovery etc.)
  • Prochlorperazine (Buccastem-M)
    (used after above treatments tried)
45
Q

What is the action of sumatriptan?

A
  • Constricts cerebral arteries

- Counteracts cranial vasodilatation

46
Q

Who is sumatriptan licensed for OTC?

A

For acute migraine attack:

  • 18 - 65 y/o
  • with or w/o aura
47
Q

What is the dose for sumatriptan?

A
  • 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
Q

What is sumatriptan’s side effect profile?

A

Mild and transient

49
Q

What contraindications are there for sumatriptan?

A
  • SSRIs
  • MAOIs (monoamine oxidase inhibitors)
  • Moclobemide
  • St John’s Wort
  • Other vasoconstrictor migraine treatment e.g. ergotamine (Migril), Methysergide (Deseril)
50
Q

What conditions would restrict sumatriptan supply?

A
  • Pregnant/breastfeeding
  • CVD
  • Hypertension
  • Peripheral vascular disease
  • Liver/kidney disorder
  • Neurological conditions including epilepsy
51
Q

When would you refer a patient taking sumatriptan?

A
  • 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
Q

What is a cluster headache and how is it characterised?

A
  • Steady intense unilateral orbital boring pain
  • Usually occurs same time each day
  • Lasts 10 minutes to 3 hours
  • REFER
53
Q

Who do cluster headaches most often affect?

A
  • Men in their 20s

- 6:1 Male:Female ratio

54
Q

What is a traction headache? Examples of causes?

A

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
Q

What’s the differential diagnosis of a traction headache?

A
  • 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
Q

What are the red flags for headache?

A
  • 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

B32PAI - Clinical & Pharmacy Practice (5 decks)

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