Pain Flashcards
What is acute pain
Less than 12 weeks
What is chronic pain
More than 12 weeks
What is a non drug treatment for pain
TENS
What are some adjuvant therapies for pain
Antidepressants, benzos and muscle relaxants
What is given in musculoskeletal pain
Paracetamol, aspirin and NSAIDs
What is given in sickle cell pain
Mild - paracetamol, NSAIDs, codeine
Severe crisis - morphine
What does pethidine cause
Seizures - so avoid this
What is given in dental/orofacial pain
benzyldamine mouthwash, paracetamol, NSAIDs
Opioids hardly ever required
What is given in period pain
Paracetamol, NSAIDs. Can give antiemetic as well if need be
When are NSAIDS given
Pain and inflammation
How should you avoid the gastric issues with NSAIDs
Give after foodD
Does paracetamol have any anti-inflammatory activity
No
When is nefopam used
May be useful in persistent pain that is unresponsive to other analgesics. It can have antimuscarinic effects which can be troublesome
What is caffeine
Weak stimulant
Is co-proxamol still licensed
No - toxic
What is given in post operative analgesia
Morphine
What is given for neuropathic pain
Amitriptyline, Nortriptyline, Gabapentin and Tramadol
Can capsaicin cream cause burning
Yes it can
Are NSAIDs effective in migraines
Yes
What else are given in migraines apart from NSAIDs
Triptans (5HT1 receptor agonists)
Sumatriptan - first choice
What if there is failed monotherapy with sumatriptan?
Sumatriptan+ naproxen
What 2 drugs can be given for headaches
Metoclopramide and promethazine
What is the pain ladder
1 - Non opioid (aspirin, paracetamol, NSAID)
2- Weak opioid (Codeine, dihydrocodeine, meptazinol)
3 - Strong opioid ( morphine, buprenorphine, diamorphine, fentanyl, oxycodone, tramadol)
What are some main cautions with opioids?
Respiratory depression
Bradycardia
Sleepiness
Reduced concentration
Cyanosis
Vivid dreams, hallucinations
Convulsions
Pinpoint pupils
What are some withdrawal signs with dependence on opioids
Sweating, tremor, D, N+V
Can tolerance occur with opioids?
Yes they can - after long term treatment
Opioids and alcohol
Sedation and hypotension
Tramadol and coumarins
Increased anticoagulation effect
Rifampicin and fentanyl/morphine/codeine/methadone/alfentanil
Reduced effects of fentanyl
What can happen when opioids are given with MAOIs
CNS excitation/depression
What is the opioid of choice in palliative care
Morphine
What has both agonist and antagonist properties?
Buprenorphine - has abuse potential too
What drug is partially reversed by naloxone
Buprenorphine
What is less sedating - methadone or morphine
Methadone - longer duration of action
Is oxycodone similar to morphine?
Yes - used when Morphine is not tolerated
Is codeine a weak opioid?
Yes
How can codeine be converted into morphine?
Hepatic codeine metabolism produces morphine and this capacity to metabolise codeine varies
What is the contraindications of codeine?
Under 12
Ultra rapid metabolisers
Breastfeeding
Children with respiratory problems
What should you monitor in fentanyl
Fever
Risk of respiratory depression
Remove if breathing issues, drowsiness, confusion and impaired speech
