pain Flashcards
which opioid would you avoid in sickle cell disease bc of risk of seizure?
pethidine
when is nefopam used in pain relief?
when pain not responding to non opioid analgesics
which conditions need to cautioned with opioids? [3]
impaired respiratory function eg asthma, copd, hypertension,
what are the side effects of opioids?
respiratory depression dependance n&v constipation dry mouth biliary spasm drowsiness
what are the s/e of opioid overdose
pinpoint pupils
coma
respiratory depression
what are the 2 s/e with long term opioid use?
hypogonadism [sex glands called gonads produce little sex hormones]
adrenal insufficiency
what can the use of opioids during pregnancy cause?
respiratory depression and withdrawal symptoms
gastric stasis [delayed gastric emptying]
which opioid has BOTH opioid agonist and antagonist properties
buprenorphrine
what is the pt and carer advice regarding buprenorphine patches?
- apply to dry non hairy area on upper torso or outer arm
- dont apply to same area for at least 3 weeks [6 days for transtec]
- avoid heat bc can increase absorption
- remove if causing breathing difficulties/ confusion etc
which analgesics can be used for neuropathic pain?
amitriptyline, nortriptyline, gabapentin, pregabalin, tramadol
lidocaine patches
capsaicin cream
what is 1st line in acute migraines [2]?
what can be used if these are ineffective?
soluble paracetamol and aspirin
5ht1 receptor agonists eg triptans
which NSAID is specifically licensed in migraine attacks?
tofenamic acid
which 5ht1 receptor agonists [triptans] are used for cluster headaches? [2]
sumatriptan and zolmitriptan
how many times a month can ergotamine tartate [for migraines] be used?
max twice a month
in which patients, suffering with migraines, is preventative drug treatment offered in? [3]
- those who suffer 2 or more attacks a month
- those who suffer increasing frequency of headaches
- those suffering disability from migraine despite treatment
which medications can be used in migraine PROPHYLAXIS? [7]
- beta blockers eg propanolol
- TCAs
- gabapentin
- topiramate
- sodium valproate
- pizotifen
- botulinum toxin type A
cluster headaches are more severe than migraines
what is their treatment?
what can be given as alternatives?
sumatriptan SC injection
alternatively sumatriptan nasal spray or zolmitriptan
what can be used to abort an attack of a cluster headache?
100% oxygen for 10-20 mins
when is PROPHYLAXIS treatment of a cluster headache considered?
when attacks are more frequent
when they last more than 3 weeks
what drugs are used in cluster headache PROPHYLAXIS?
verapamil
lithium
prednisolone
ergotamine tartate
what are the symptoms of cluster headaches?
a red and watering eye drooping and swelling of 1 eyelid a smaller pupil in 1 eye a sweaty face a blocked or runny nostril
what can be given to help smoking cessation? [3]
nicotine replacement therapy
bupropion
varenicline
what are the s/e of Nicotine replacement therapy oral sprays?
patches?
lozenges
patches?
oral spray: increase salivation, paraesthesia [burning sensation in arms and feet], sweating, myalgia [muscle pain], rash and hot flushes
patches: abnormal dreams
lozenges: rash and hot flushes
patches: sweating and myalgia
which 2 drugs are used for opioid dependance?
methadone
buprenorphine
what should the pt be assessed for if they have missed 5 or more days of methadone/buprenorphine?
assess pt for illicit drug use eg have they taken drugs from the street
which out of buprenorphine or methadone has lowest risk of over dose and less sedating?
buprenorphine
why should acute withdrawal of opioids be avoided in pregnancy?
what can opioid withdrawal [eg methadone] in the 1st trimester cause?
fetal death
spontaneous misscarriage
what is naltrexone?
prevents relapse in opioid dependant pt
what is lofexidine used for?
to alleviate physical symptoms of opioid withdrawal
what is 1st line in alcohol dependance treatment and what are alternatives\?
1st line: long acting benzodiazepines eg chlordiazepoxide and diazepam
alternatives: carbamazepine, clomethiazole
what is delirium tremens?
what is 1st line to treat it and what is the alternative treatment?
pt experiencing agitation, confusion, paranoia, visual and auditory hallucinations
1st line: lorazepam oral
alternative: haloperidol or parenteral lorazepam
what is the treatment of wernickes encephalopathy?
parenteral thiamine then oral thiamine
