Pain

Question 1

How is choice of pain medication determined?

Answer 1

depends on
- severity of pain
- type = somatic or neuropathic
- cause
- previous exposure to analgesics
- duration of pain
- patient’s expectation regarding pain control

Question 2

How is severity of pain determined?

Answer 2

facial expressions
groaning
ability to move
timing of pain
number of sites of pain
patient’s own perception of pain

Question 3

What are the steps of the pain ladder?

Answer 3

step 1
- paracetamol, ibuprofen, naproxen

step 2
- codeine, tramadol, meptazinol

step 3
- morphine, oxycodone

Question 4

Which opioids are pure agonists, partial agonists and antagonists?

Answer 4

pure agonists
- morphine, codeine

partial agonist
- buprenorphine
= used to treat addiction/opioid dependence

anatagonist
- naloxone
= is given i.v to treat drug overdose

Question 5

How does tramadol work? What are the side effects?

Answer 5

opioid effect
enhances serotonergic and adrenergic pathways
- is less likely to cause constopation and respiratory distress

side effects
- convulsions
- psychiatric reactions
- serotonin syndrome
= shivering, muscle spasms, confusion, diarrhoea

Question 6

What is minimum effective dose?

Answer 6

minimum effective dose
- total daily dose = regular dose + breakthrough dose

Question 7

How do you work out the morphine dose for breakthrough pain?

Answer 7

breakthrough pain dose/rescue dose
= 1/6 - 1/10 of total daily dose

Question 8

How do you convert from morphine to diamorphine dose?

Answer 8

oral diamorphine dose is approximately 1/3 of the oral morphine dose

Question 9

What are the side effects of opioids?

Answer 9

hypotension
nausea
vomiting
constipation
drowsiness
rash/skin reaction
respiratory depression

Question 10

What is the difference between buccal and sublingual administration?

Answer 10

buccal
- dosage is held between the gum and cheek

sublingual
- dosage is held under the tongue