Pain

Question 1

Analgesics

Answer 1

NSAIDs, aspirin and paracetamol - musculoskeletal pain

Opioid - visceral pain (mod/severe pain)

Question 2

Sickle cell disease

Answer 2

Paracetamol, NSAIDs, codeine and dihydrocodeine

Severe - morphine/diamorphine

Question 3

Selective COX 2 inhibitors preferred in which patients?

Answer 3

High risk of GI side effects

Question 4

Opioids

Answer 4

Repeated use may cause dependence/tolerance

Caution in COPD, asthma, hypotension, MG, shock and convulsions

Question 5

Side effects:

Answer 5

Resp depression - reversed by naloxone
Tolerance
OD - coma, resp depression, pin-point pupils
Constipation
N+V

Question 6

Buprenorphine

sched 3

Answer 6

Opioid agonist/antag - abuse potential
6-8 hours sublingually
Partially reversed by naloxone

Question 7

Buprenorphine patches

• apply to a non-irritated/hairy, dry skin on upper torso/outer arm
• heat/fever can inc absorption
• remove if s.e occurs e.g. confusion, dizziness

Answer 7

72hrly - hapoc, prenotrix

96hrly - bupeaze, transtec

7 days - butec, butrans

Question 8

Tramadol

Answer 8

Opioid - enhancement of seratogenic/adren pathways