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PR - CNS > PAIN > Flashcards

PAIN Flashcards

1
Q

Avoid in sickle-cell disease

A

Pethidine

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2
Q

Dental pain

A
  • Paracetamol, NSAIDs, aspirin
  • Opioids rarely used due to SEs
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3
Q

Anti-pyretic and anti-inflammatory

A

NSAIDs
Aspirin

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4
Q

Only anti-pyretic

A

Paracetamol

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5
Q

Aspirin CI

A
  • Under 16
  • Peptic ulcer/ history of ulceration
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6
Q

Aspirin main SE

A
  • Gastric irritation
  • After food
  • E/C or GR preps
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7
Q

Disadvantage of EC asirin

A
  • Slow onset of action
  • Unsuitable for single dose
  • May be suitable for night pain
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8
Q

Paracetamol risks

A
  • Overdose
  • May not be apparent until 4-6 days later
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9
Q

Which is preferred in elderly? Paracetamol or ibuprofen?

A

Paracetamol

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10
Q

Paracetamol - minimum age

A

2 months

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11
Q

Can paracetamol be sold over the counter for fever prophylaxis following
immunisation for 2 months old?

A

yes

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12
Q

REMEMBER: What are the doses of paracetamol in children?
Paracetamol infant (120mg/ 5ml)

A

Child 1-2 months (NOT OTC)
30-60mg
* 2 to 6 months: 2.5ml
* 6 months - 24months: 5ml
* 2-4yrs: 7.5ml
* 4-6yrs: 10ml

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13
Q

Paracetamol six plus susp (250mg/5ml)

A
  • 6-8yrs: 5ml
  • 8-10yrs: 7.5ml
  • 10-12yrs: 10ml
  • 12-16 years: 10-15ml
    Above 16yrs you can give up to 1g (10-20ml)
    All (apart from first one) every 4-6 hours
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14
Q

When is Paracetamol
OTC licensed for 2 month old babies?

A

ONLY for relief/prophylaxis of tever post-vaccination
i.e. do not give for general pain

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15
Q

Which paracetamol oral suspension is not licensed for use in children under 16
years old?

A

500mg/5ml (POM)

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16
Q

What is the dose of paracetamol in adults?

A

0.5 - 1g every 4-6 hours
MAX 4g a day (8 500mg
tablets)

17
Q

Which patients may be at risk of experiencing toxicity from paracetamol at a therapeutic dose?

A
  • <50kg
  • hepatoxicity
  • taking liver enzyme-inducing drugs (e.g. carbamazepine, phenytoin, rifampicin)
18
Q

What can be a sign of a paracetamol overdose?

A
  • N&V (usually settles within 24 hours
  • Right subcostal pain and tenderness usually indicates development of hepatic necrosis
19
Q

If someone who is obese has a
paracetamol overdose, which weight do you use to calculate the dose of paracetamol they took?

A

If they weigh more than 110kg, use their actual weight per mg to not underestimate the toxic effects of paracetamol

20
Q

What do you give for paracetamol overdose and when is it the most effective?

A
  • Acetylcysteine (IV)
  • Most effective within 8 hours of ingestion, after which effectiveness declines
21
Q

Nefopam

A

It is a non-opioid, centrally-acting analgesic
It is used for the relief of persistent pain unresponsive to other non-opioid analgesics

22
Q

What are the side-effects of Nefopam?

A
  • Sympathomimetic and anti-muscarinic (dry mouth, drowsiness, urinary incontinence, etc.)
  • IT DOES NOT CAUSE
    RESPIRATORY DEPRESSION
23
Q

What is the World
Health Organization
(WHO) pain ladder?

A

Step 1:
- NON-opioid
- e.g. Paracetamol, NSAID, Aspirin
Step 2:
- Weak opioid + non-opioid
- e.g. Codeine and
paracetamol
Step 3:
- Strong opioid + non-opioid
- E.g. Morphine and paracetamol

Each step you can either add adjuvants or not
Examples of adjuvants e.g.
Amitriptyline, Gapapentin, Pregabalin, Antiepileptics e.g. carbamazepine

24
Q

How often are opioids administered in chronic pain?

A

Either as:
* IR preps every 4 hours
OR
* MR preps every 12 hours
* Rescue doses (for breakthrough pain) may be given in addition

25
Q

Breakthrough pain

A
  • This is when patients experience symptoms of pain despite taking their correct dose of regular opioid
  • They would be given rescue doses in between their main doses of opioids (i.e. Morning and evening)
26
Q

How do you calculate the rescue dose for breakthrough pain?

A

1/10th to 1/6th of the regular
24 hour dose
This dose is given every 2-4 hours when required!!

27
Q

When would you need to review pain
management at a regular opioid dose?

A
  • If rescue dose is needed frequently, e.g. twice a day or more
28
Q

Let’s say morphine was used to control pain, how would you titrate up morphine?

A

Increments of morphine should not exceed 1/3 to a HALF of the total daily dose every 24 hours
The titration would stop once the pain is controlled or unacceptable adverse effects occur

29
Q

How do you treat low back pain?

A
  1. Oral NSAID
    OR
  2. Weak opioids with or without paracetamol
    - ONLY if NSAID is not tolerated, Cl or ineffective

Benzodiazepines are sometimes used (evidence is weak)

PR - CNS (61 decks)

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