Pain

Question 1

Which analgesics are more suitable in musculoskeletal pain, opioid or NSAIDS?

Answer 1

NSAIDs

Question 2

Which analgesics are more suitable for pain of visceral origin, moderate or severe pain?

Answer 2

Opioid analgaesics

Question 3

Analgaesic for mild sickle-cell crisis

Answer 3

Paracetamol, a NSAID, Codeine or Dihydrocodeine

Question 4

Analgaesic for severe crisis

Answer 4

Morphine, Diamorphine and concomitant use of a NSAID may potentiate analgesia and allow lower doses of opioid use.

Question 5

Pethidine warning and length of half life

Answer 5

Accumulation of neurotoxic metabolites can precipitate seizures.

Short half-life necessitates frequent injections

Question 6

Suitable analgesia for acute problems of the oral mucosa

Answer 6

Benzydamine (mouthwash or spray Difflam)

Question 7

Analgaesic adequate for dental pain

Answer 7

Paracetamol, ibuprofen or aspirin.

An opioid is rarely used.

Question 8

Advantage of Diamorphine (heroin) over morphine

Answer 8

Higher solubility so smaller volumes can be injected. Especially suitable in emaciated patients.

Less nausea and hypotension

Question 9

Why is co-proxamol (dextropropoxyphene in combination with paracetamol) no longer a licensed medicine?

Answer 9

Safety concerns. Toxicity overdose.

Used as an unlicensed drug

Question 10

When is Nefopam used?
Nefopam advantage over opioids?
Nefopam side effects

Answer 10

Persistent pain unresponsive to other non-opioid analgesics.

Causes little or no respiratory depression

Sympatomimetic and antimuscarinic:

fine tremor, usually in the hands.

nervous tension.

headache.

peripheral vasodilation.

sinus tachycardia.

hypersensitivity, including paradoxical bronchospasm.

impaired glucose tolerance in diabetics.

Question 11

Nefopam can colour urine….

Answer 11

Red (rare)

Question 12

Advantage of buprenorphine over morphine?
Buprenorphine mechanism of action?

How is buprenorphine affected by naloxone?

Answer 12

Longer duration of action 6 to 8 hours
Buprenorphine is both an opioid receptor agonist and partial agonist. May antagonise the effect of previously administered opioids and is generally not recommended.

Buprenorphine is only partially reversed by naloxone

Question 13

Methadone advantage over morphine?

Maximum frequency of dosing in a day?

Answer 13

Less sedating and acts for longer periods

Twice daily dosing to avoid risk of accumulation and opioid overdosage

Question 14

Pethidine compared to morphine?

Answer 14

Less potent but less constipating. Can be used for analgesia in labour

Question 15

Tramadol mechanism of action?

Answer 15

Opioid effect and an enhancement of serotonergic and adrenergic pathways

Question 16

Are fentanyl films bioequivalent to other fentanyl preparations?

Answer 16

No

Question 17

Are fentanyl preparations for the treatment of breakthrough pain interchangeable?

Answer 17

Fentanyl preparations for the treatment of breakthrough pain are not interchangeable; if patients are switched from another fentanyl-containing preparation, a new dose titration is required.

Question 18

Which patients does the manufacturer recommend use of fentanyl transdermal patches?

Answer 18

Opioid tolerant patients. Transdermal patches can cause fatal respiratory depression in opioid naïve patients.

Question 19

Morphine 24hrly mr preparation is ….?

Answer 19

MXL

Question 20

Morphine 12hrly mr preparation is……?

Answer 20

Zomorph, Morphegesic, MST

Question 21

Immediate release morphine oral preparations are …..?

Answer 21

4 hrly

Question 22

Morphine oral solution above 13mg/5mL is which controlled drug schedule?

Answer 22

Schedule 2