Pain Flashcards
What’s chronic pain
Pain greater than 12weeks
Depression is a Common comorbidity with chronic pain. True or false?
True
What’s primary chronic pain
No clear underlying condition
WHO pain ladder
See photo
What drug is useful in musculoskeletal pain
Nsaids, aspirin and PCM
List drugs used in sickle cell disease
Paracetamol and Nsaids, codeine and dihydrocodeine
Drugs used in severe crisis in sickle cell disease
Morphine or diamorphine may be needed
Drugs to avoid in sickle cell disease
Pethidine because it can cause seizure
Dental pain and orofacial pain tx
NSAIDs ( Ibuprofen, Aspirin, Diclofenac) use pcm temporary
Benzydamine mouthwash/spray can be used
Diazepam a muscle relaxant and Anxiolytics used short term
Dysmenorrhoea tx
Antiemetic to prevent vomiting
Pcm and NSAID used to provide relief
Oral contraceptive can be used to prevent pain associated with ovulatory cycles
A non-opiod analgesic used to tx headache, musculoskeletal pain , dysmenorrhoea and pyrexia is ….
Aspirin
State what to do to prevent GI problems associated with aspirin
Take dose after food , enteric coated preps have slow onset of action and therefore unsuitable
Aspirin interacts with…
Other drugs especially warfarin which is a special hazard
What drug can be used for pain not responding to non opiod analgesic but has more side effects
Nefopam
Indication of NSAID
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
What drug is preferred over NSAIDs for patients with high risk of G.I side-effects
Cyclo-oxygenase 2
Facts about caffeine
It is a weak stimulant and enhances analgesic effect
Facts about Opiods analgesic
To relief moderate- severe pain of visceral origin
Repeated used may cause dependence and tolerance
Caution with opiod analgesic
Caution in impaired respiratory function, asthma, hypotension, MG, shock, convulsive disorder
Opiod analgesic should be avoided in…
COPD
Some opiod side effects
Respiratory depression- reversed by naloxone or artificial ventilation
Overdose can cause coma, Respiratory depression and pinpoint pupils
Other side effects of opoid
Constipation
Dry mouth
N and V
Biliary spasm
Drowsiness
LT use - hypogonadism and adrenal insufficiency
Larger doses- muscle rigidity, hypotension, Respiratory depression
Pt and carer advice for opoids
Drowsiness, may affect driving or skilled task
Facts about morphine as a strong opiod
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
Facts about Buprenorphine
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
Patients and carer advice on the use of buprenorphine patches
Apply patch to dry, non irritated, non hairy skin on upper torso or outer
arm
Avoid heat and sauna as they can increase absorption
Remove after 72hrs/ 96hrs/ 7days
Avoid same area for atleast 3 weeks
Remove if breathing difficulties, drowsiness, confusion or dizziness
Examples of patch applied for 7days
Prenotrix, hapoctasin , bupeaze, buplast and relevtec
State patch applied for 6 days
Transtec
Which buprenorphine patch that is applied weekly
Butec
Butrans
Reletrans
Sevodyne
Panitaz
Bupramyl
Buprenorphine patch applied 4days/96hrs
Bupeaze
Buplast
Relevtec
Transtec
Buprenorphine patches applied for 3days/72hrs
Prenotrix
Hapoctasin
Facts about methadone
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
What’s Oxycodone used for
Pain control in palliative care
Facts about pethidine
Less constipating than morphine
Prompt but short lasting analgesia
Facts about Tramadol
Analgesia by opiod effect and enhancement of serotogenic and adrenergic pathway
Drugs used to tx neuropathic pain
Amitriptyline, nortriptyline, pregabalin, gabapentine and tramadol
Plasters can be used
Capsaicin cream- burning sensation can occur during initial tx and limit use
Tx of acute Migraine
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
What medication is licensed specifically for Migraine attacks
Tofenamic acid
Other drugs licenced for Migraine attacks
Diclofenac, potassium, flurbiprofen and Ibuprofen
A 5HT1 agonist used to tx cluster headaches is
Zolmitriptan and sumatriptan
List the type of Migraine Triptans not indicated for
Hemiplegic, basillar or opthalmoplegic Migraine
An example of ergot alkaloid use to tx Migraine
Ergotamine tartrate
Use to manage cluster headaches
An antiemetic used in Migraine that promote gastric emptying and normal peristalsis is known as
Domperidone and Metoclopramide
List examples of medication used in Migraine prophylaxis
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)
Drugs used to tx cluster headaches
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
Drugs used for prophylaxis of cluster headache
Attacks last greater than 3weeks
Can’t be treated effectively
Verapamil or lithium ( unlicensed)
Prednisone ( short term)
Ergotamine tartate
