Pain

Question 1

What is the max dosage of paracetamol in 24 hours?

Answer 1

4 grams

Question 2

Which liver marker can be used to assess liver damage in paracetamol overdose?

Answer 2

ALT

Question 3

Which anticoagulant medication can interact with paracetamol?

Answer 3

Warfarin

Question 4

Which antidote is given for paracetamol poisoning? This is infused over how long?

Answer 4

Acetylcysteine over 1 hour

Question 5

Acetylcysteine should be commenced in patients presenting 8-24 hours after paracetamol ingestion who have taken how much mg/kg?

Answer 5

Over 150mg/kg

Question 6

King’s College criteria for paracetamol induced liver failure states that pH of below what is indicative of liver transplant?

Answer 6

7.3

Question 7

State the following Kings College criteria for paracetamol induced liver failure transplant:
1. Prothrombin time
2. Creatinine
3. Grade of encephalopathy

Answer 7

1. PT over 100 seconds
2. Creatinine over 300
3. Grade III or IV encephalopathy

Question 8

PPIs should be co-prescribed with NSAIDs in patients over what age?

Answer 8

45

Question 9

What is the first line class of analgesia in back pain?

Answer 9

NSAIDs

Question 10

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?

Answer 10

NSAIDs

Question 11

Which NSAID is contraindicated in ischaemic heart disease, peripheral arterial disease and congestive heart failure?

Answer 11

Diclofenac

Question 12

What is the max dose of ibuprofen per day?

Answer 12

2.4g

Question 13

Tramadol has a dual action of what?

Answer 13

Weak opioid plus serotonin and noradrenaline reuptake inhibitor

Question 14

Which weak opioid lowers seizure threshold?

Answer 14

Tramadol

Question 15

Which weak opioid can be utilised in neuropathic pain?

Answer 15

Tramadol

Question 16

State the effect of opioids on:
1. Respiratory rate
2. Pupils
3. Gastric motility
4. Bronchus

Answer 16

1. Depresses respiration
2. Constricts pupils
3. Reduces gastric motility
4. Bronchoconstriction

Question 17

What is the most common side effect of opioids?

Answer 17

Constipation

Question 18

State the calculation for converting oral morphine dose to:
1. Subcutaneous
2. IV

Answer 18

1. Half
2. Third

Question 19

How is opioid overdose managed?

Answer 19

IV or IM naloxone

Question 20

Morphine is metabolised by what organ?

Answer 20

Liver

Question 21

Fill in the blank:
Weak opioids are __% the potency of morphine

Answer 21

10%

Question 22

Fill in the blank:
Oxycodone is __ x the potency of morphine

Answer 22

1.5-2

Question 23

Fill in the blank:
Breakthrough dose of morphine is __ of daily morphine dose

Answer 23

1/6

Question 24

How many mg per day of morphine should we give to opioid naive patients in the first instance?

Answer 24

20-30mg

Question 25

Which strong opioid should be used in mild to moderate renal impairment?

Answer 25

Oxycodone

Question 26

Which 2 strong opioids can be used in severe renal impairment?

Answer 26

Fentanyl and buprenorphine

Question 27

If still requiring breakthrough medication regularly, by what percentage may we increase a strong opioid in palliative patients?

Answer 27

30-50%

Question 28

What is the first line treatment for headaches caused by cerebral metastases?

Answer 28

Dexamethasone

Question 29

What 2 treatments may be offered in those with bone pain due to metastases?

Answer 29

IV bisphosphonate infusion and/or radiotherapy

Question 30

Muscle spasm pain in palliative patients may be managed by what 2 medications?

Answer 30

Diazepam or baclofen

Question 31

Suspected spinal cord compression due to metastases can be managed by administering what medication?

Answer 31

Dexamethasone

Question 32

How many neuropathic painkillers can be concurrently taken?

Answer 32

One

Question 33

Which neuropathic pain killer is the safest to use in renal impairment?

Answer 33

Amitriptyline

Question 34

Which neuropathic painkiller is utilised in trigeminal neuralgia?

Answer 34

Carbamazepine