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CNS > pain > Flashcards

pain Flashcards

1
Q

which opioid would you avoid in sickle cell disease bc of risk of seizure?

A

pethidine

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2
Q

when is nefopam used in pain relief?

A

when pain not responding to non opioid analgesics

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3
Q

which conditions need to cautioned with opioids? [3]

A

impaired respiratory function eg asthma, copd, hypertension,

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4
Q

what are the side effects of opioids?

A 
respiratory depression
dependance
n&v
constipation 
dry mouth
biliary spasm
drowsiness
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5
Q

what are the s/e of opioid overdose

A

pinpoint pupils
coma
respiratory depression

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6
Q

what are the 2 s/e with long term opioid use?

A

hypogonadism [sex glands called gonads produce little sex hormones]
adrenal insufficiency

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7
Q

what can the use of opioids during pregnancy cause?

A

respiratory depression and withdrawal symptoms

gastric stasis [delayed gastric emptying]

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8
Q

which opioid has BOTH opioid agonist and antagonist properties

A

buprenorphrine

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9
Q

what is the pt and carer advice regarding buprenorphine patches?

A
  • 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
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10
Q

which analgesics can be used for neuropathic pain?

A

amitriptyline, nortriptyline, gabapentin, pregabalin, tramadol
lidocaine patches
capsaicin cream

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11
Q

what is 1st line in acute migraines [2]?

what can be used if these are ineffective?

A

soluble paracetamol and aspirin

5ht1 receptor agonists eg triptans

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12
Q

which NSAID is specifically licensed in migraine attacks?

A

tofenamic acid

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13
Q

which 5ht1 receptor agonists [triptans] are used for cluster headaches? [2]

A

sumatriptan and zolmitriptan

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14
Q

how many times a month can ergotamine tartate [for migraines] be used?

A

max twice a month

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15
Q

in which patients, suffering with migraines, is preventative drug treatment offered in? [3]

A
  • those who suffer 2 or more attacks a month
  • those who suffer increasing frequency of headaches
  • those suffering disability from migraine despite treatment
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16
Q

which medications can be used in migraine PROPHYLAXIS? [7]

A
  1. beta blockers eg propanolol
  2. TCAs
  3. gabapentin
  4. topiramate
  5. sodium valproate
  6. pizotifen
  7. botulinum toxin type A
17
Q

cluster headaches are more severe than migraines
what is their treatment?
what can be given as alternatives?

A

sumatriptan SC injection

alternatively sumatriptan nasal spray or zolmitriptan

18
Q

what can be used to abort an attack of a cluster headache?

A

100% oxygen for 10-20 mins

19
Q

when is PROPHYLAXIS treatment of a cluster headache considered?

A

when attacks are more frequent

when they last more than 3 weeks

20
Q

what drugs are used in cluster headache PROPHYLAXIS?

A

verapamil
lithium
prednisolone
ergotamine tartate

21
Q

what are the symptoms of cluster headaches?

A 
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
22
Q

what can be given to help smoking cessation? [3]

A

nicotine replacement therapy
bupropion
varenicline

23
Q

what are the s/e of Nicotine replacement therapy oral sprays?
patches?
lozenges
patches?

A

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

24
Q

which 2 drugs are used for opioid dependance?

A

methadone

buprenorphine

25
Q

what should the pt be assessed for if they have missed 5 or more days of methadone/buprenorphine?

A

assess pt for illicit drug use eg have they taken drugs from the street

26
Q

which out of buprenorphine or methadone has lowest risk of over dose and less sedating?

A

buprenorphine

27
Q

why should acute withdrawal of opioids be avoided in pregnancy?
what can opioid withdrawal [eg methadone] in the 1st trimester cause?

A

fetal death

spontaneous misscarriage

28
Q

what is naltrexone?

A

prevents relapse in opioid dependant pt

29
Q

what is lofexidine used for?

A

to alleviate physical symptoms of opioid withdrawal

30
Q

what is 1st line in alcohol dependance treatment and what are alternatives\?

A

1st line: long acting benzodiazepines eg chlordiazepoxide and diazepam

alternatives: carbamazepine, clomethiazole

31
Q

what is delirium tremens?

what is 1st line to treat it and what is the alternative treatment?

A

pt experiencing agitation, confusion, paranoia, visual and auditory hallucinations

1st line: lorazepam oral

alternative: haloperidol or parenteral lorazepam

32
Q

what is the treatment of wernickes encephalopathy?

A

parenteral thiamine then oral thiamine

CNS (11 decks)

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