Pain Flashcards
What is the max dosage of paracetamol in 24 hours?
4 grams
Which liver marker can be used to assess liver damage in paracetamol overdose?
ALT
Which anticoagulant medication can interact with paracetamol?
Warfarin
Which antidote is given for paracetamol poisoning? This is infused over how long?
Acetylcysteine over 1 hour
Acetylcysteine should be commenced in patients presenting 8-24 hours after paracetamol ingestion who have taken how much mg/kg?
Over 150mg/kg
King’s College criteria for paracetamol induced liver failure states that pH of below what is indicative of liver transplant?
7.3
State the following Kings College criteria for paracetamol induced liver failure transplant:
1. Prothrombin time
2. Creatinine
3. Grade of encephalopathy
- PT over 100 seconds
- Creatinine over 300
- Grade III or IV encephalopathy
PPIs should be co-prescribed with NSAIDs in patients over what age?
45
What is the first line class of analgesia in back pain?
NSAIDs
Oligohydramnios and constriction of the ductus arteriosus are foetal side effects which may occur when prescribing which class of analgesics from week 20 of pregnancy?
NSAIDs
Which NSAID is contraindicated in ischaemic heart disease, peripheral arterial disease and congestive heart failure?
Diclofenac
What is the max dose of ibuprofen per day?
2.4g
Tramadol has a dual action of what?
Weak opioid plus serotonin and noradrenaline reuptake inhibitor
Which weak opioid lowers seizure threshold?
Tramadol
Which weak opioid can be utilised in neuropathic pain?
Tramadol
State the effect of opioids on:
1. Respiratory rate
2. Pupils
3. Gastric motility
4. Bronchus
- Depresses respiration
- Constricts pupils
- Reduces gastric motility
- Bronchoconstriction
What is the most common side effect of opioids?
Constipation
State the calculation for converting oral morphine dose to:
1. Subcutaneous
2. IV
- Half
- Third
How is opioid overdose managed?
IV or IM naloxone
Morphine is metabolised by what organ?
Liver
Fill in the blank:
Weak opioids are __% the potency of morphine
10%
Fill in the blank:
Oxycodone is __ x the potency of morphine
1.5-2
Fill in the blank:
Breakthrough dose of morphine is __ of daily morphine dose
1/6
How many mg per day of morphine should we give to opioid naive patients in the first instance?
20-30mg
Which strong opioid should be used in mild to moderate renal impairment?
Oxycodone
Which 2 strong opioids can be used in severe renal impairment?
Fentanyl and buprenorphine
If still requiring breakthrough medication regularly, by what percentage may we increase a strong opioid in palliative patients?
30-50%
What is the first line treatment for headaches caused by cerebral metastases?
Dexamethasone
What 2 treatments may be offered in those with bone pain due to metastases?
IV bisphosphonate infusion and/or radiotherapy
Muscle spasm pain in palliative patients may be managed by what 2 medications?
Diazepam or baclofen
Suspected spinal cord compression due to metastases can be managed by administering what medication?
Dexamethasone
How many neuropathic painkillers can be concurrently taken?
One
Which neuropathic pain killer is the safest to use in renal impairment?
Amitriptyline
Which neuropathic painkiller is utilised in trigeminal neuralgia?
Carbamazepine
