Pain Flashcards

1
Q

What’s chronic pain

A

Pain greater than 12weeks

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2
Q

Depression is a Comoros comorbidity with chronic pain. True or false?

A

True

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3
Q

What’s primary chronic pain

A

No clear underlying condition

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4
Q

WHO pain ladder

A

See photo

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5
Q

What drug is useful in musculoskeletal pain

A

Nsaids, aspirin and PCM

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6
Q

What drug is used in visceral pain and moderate to severe pain

A

Trunk, heart, abdominal and pelvic organ

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7
Q

List drugs used in sickle cell disease

A

Paracetamol and Nsaids, codeine and dihydrocodeine

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8
Q

Drugs used in severe crisis in sickle cell disease

A

Morphine or diamorphine may be needed

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9
Q

Drugs to avoid in sickle cell disease

A

Pethidine because it can cause seizure

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10
Q

Dental pain and orofacial pain tx

A

NSAIDs ( Ibuprofen, Aspirin, Diclofenac) use pcm temporary
Benzydamine mouthwash/spray can be used
Diazepam a muscle relaxant and Anxiolytics used short term

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11
Q

Dysmenorrhoea tx

A

Antiemetic to prevent vomiting
Pcm and NSAID used to provide relief
Oral contraceptive can be used to prevent pain associated with ovulatory cycles

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12
Q

A non-opiod analgesic used to tx headache, musculoskeletal pain , dysmenorrhoea and pyrexia is ….

A

Aspirin

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13
Q

State what to do to prevent GI problems associated with aspirin

A

Take dose after food , enteric coated preps have slow onset of action and therefore unsuitable

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14
Q

Aspirin interacts with…

A

Other drugs especially warfarin which is a special hazard

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15
Q

What drug can be used for pain not responding to non opiod analgesic but has more side effects

A

Nefopam

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16
Q

Indication of NSAID

A

Chronic disease accompanied by pain and inflammation
Short tx of mild -moderate pain but PCM more preferable esp in elderly
Suitable for dysmenorrhoea
Pain caused by secondary bone tumour
Use for post operative analgesia

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17
Q

What drug is preferred over NSAIDs for patients with high risk of G.I side-effects

A

Cyclo-oxygenase 2

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18
Q

Facts about caffeine

A

It is a weak stimulant and enhances analgesic effect

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19
Q

Facts about Opiods analgesic

A

To relief moderate- severe pain of visceral origin
Repeated used may cause dependence and tolerance

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20
Q

Caution with opiod analgesic

A

Caution in impaired respiratory function, asthma, hypotension, MG, shock, convulsive disorder

21
Q

Opiod analgesic should be avoided in…

A

COPD

22
Q

Some opiod side effects

A

Respiratory depression- reversed by naloxone or artificial ventilation
Overdose can cause coma, Respiratory depression and pinpoint pupils

23
Q

Other side effects of opoid

A

Constipation
Dry mouth
N and V
Biliary spasm
Drowsiness
LT use - hypogonadism and adrenal insufficiency
Larger doses- muscle rigidity, hypotension, Respiratory depression

24
Q

Pt and carer advice for opoids

A

Drowsiness, may affect driving or skilled task

25
Q

Facts about morphine as a strong opiod

A

Most valuable opiod analgesic for severe pain despite causing N and V
Confers euphoria and a state of detachment in addition to pain relief
Given every 4hrs
Every 12- 24hrs as MR prep

26
Q

Facts about Buprenorphine

A

Has both opiod agonist and antagonist properties
May ppt withdrawal symptoms
Abuse potential and may cause dependent
Longer duration of action than morphine
Effective sublingually for 6- 8hours
Compared to other opoids , it’s effects are only partially reversed by nalaxone

27
Q

Patients and carer advice on the use of buprenorphine patches

A

Apply patch to dry, non irritated, non hairy skin on upper torso or outer
arm
Avoid heat and sauna ad they can increase absorption
Remove after 72hrs/ 96hrs/ 7days
Avoid same area for atleast 3 weeks

Remove if breathing difficulties, drowsiness, confusion or dizziness

28
Q

Examples of patch applied for 7days

A

Prenotrix, hapoctasin , bupeaze, buplast and relevtec

29
Q

State patch applied for 6 days

A

Transtec

30
Q

Which buprenorphine patch that is applied weekly

A

Butec
Butrans
Reletrans
Sevodyne
Panitaz
Bupramyl

31
Q

Buprenorphine patch applied 4days/96hrs

A

Bupeaze
Buplast
Relevtec
Transtec

32
Q

Buprenorphine patches applied for 3days/72hrs

A

Prenotrix
Hapoctasin

33
Q

Facts about methadone

A

Less sedating than morphine
Should not be administered more than BD to prevent risk of overdose and accumulation
Pt who miss 3 or more days are at risk of OD due to tolerance , reducing dose

34
Q

What’s Oxycodone used for

A

Pain control in palliative care

35
Q

Facts about pethidine

A

Less constipating than morphine
Prompt but short lasting analgesia

36
Q

Facts about Tramadol

A

Analgesia by opiod effect and enhancement of seratogenic and adrenergic pathway

37
Q

Drugs used to tx neuropathic pain

A

Amitriptyline, nortriptyline, pregabalin, gabapentine and tramadol
Plasters can be used
Capsaicin cream- burning sensation can occur during initial tx and limit use

38
Q

Tx of acute Migraine

A

Tx guided by response and Severity of the attacks
Aspirin , soluble pcm effective
Offer 5HT1 receptor agonist if above meds ineffective
Antiemetic may be required
Excess use of Migraine medication can cause over use headache

39
Q

What medication is licensed specifically for Migraine attacks

A

Tofenamic acid

40
Q

Other drugs licenced for Migraine attacks

A

Diclofenac, potassium, flurbiprofen and Ibuprofen

41
Q

A 5HT1 agonist used to tx cluster headaches is

A

Zolmitriptan and sumatriptan

42
Q

List the type of Migraine Triptans not indicated for

A

Hemiplegic, basillar or opthalmoplegic Migraine

43
Q

An example of ergot alkaloid use to tx Migraine

A

Ergotamine tartrate
Use to manage cluster headaches

44
Q

An antiemetic used in Migraine that promote gastric emptying and normal peristalsis is known as

A

Domperidone and Metoclopramide

45
Q

List examples of medication used in Migraine prophylaxis

A

Beta blockers eg propranolol, atenolol, metoprolol, nadolol and timolol
TCAs
Gabapentine
Topimirate
Sodium valproate
Pizotifen (may cause WG)
Botulinum toxin type A( chronic migranes in adult)

46
Q

Drugs used to tx cluster headaches

A

Sumatriptans by SC injection
Sumatriptan nasal spray or Zolmitriptan (unlicensed) if injection is unsuitable
100% Oxygen at a rate of 10-15L/min for 10-20 mins is useful in aborting attack

47
Q

Drugs used for prophylaxis of cluster headache

A

Attacks last greater than 3weeks
Can’t be treated effectively
Verapamil or lithium ( unlicensed)
Prednisone ( short term)
Ergotamine tartate

48
Q
A
49
Q
A