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Inori Pre Reg > Pain > Flashcards

Pain Flashcards

1
Q

NSAIDs can reduce excretion of what drugs?

A

Lithium and methotrexate so increased risk of toxicity

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2
Q

How to increase morphine dose?

A

Every 2 to 3 days increase dose

In general, dose increases should be limited to no more than 30% of the total 24hr morphine dose

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3
Q

Why is Pethidine not suitable for long term use?

A

Accumulation of a neurotoxicity metabolite, norpethidine can precipitate seizures

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4
Q

MHRA warning on fentanyl patches?

A

Life-threatening and fatal opioid toxicity from accidental exposure, particularly in children

  • avoiding touching the adhesive side of patches, and washing hands after application;
  • not cutting patches and avoid exposure of patches to heat including via hot water;

Transdermal fentanyl patches for non-cancer pain: do not use in opioid-naive patients

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5
Q

Why is codeine restricted in children?

A

A serious and life threatening toxicity in children with obstructive sleep apnoea
So not recommended in children with breathing issues (severe cardiac or Respiratory issues, Respiratory infection, neuromuscular disorders)

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6
Q

Max dose of codeine in 12-18?

A

240mg

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7
Q

Warning labels of paracetamol?

A

Do not take more than 2 at any one time
Do not take more than 8 in a day

Contains paracetamol. Do not take anything else containing paracetamol while taking this med. Talk to a doctor at once if you take too much of this med, even if you feel well

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8
Q

Overdose symptoms of paracetamol?

A

Liver damage. Higher risk of hepatotoxicity if under 50kg

N&V
Right subcostal pain /tenderness

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9
Q

Treatment of paracetamol poisoning?

A

Acetylcysteine

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10
Q

What’s the usual dose and max dose of aspirin when used as an NSAID?

A

300-909mg every 4-6hrs PRN

Max 4g/day

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11
Q

Cautionary and advisory label of aspirin?

A

Take with or just after food

Contains aspirin. Do not take anything else containing aspirin while taking this med

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12
Q

Side effects of aspirin?

A

GI irritation

Tinnitus in high doses

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13
Q

Age contraindications of aspirin and why?

A

Under 16 bc of reyes syndrome

Except if you have kawasaki disease or need it as an Antiplatelet

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14
Q

What is reyes syndrome?

A

Swelling in the liver and brain

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15
Q

Long term use of Opioids can lead to what

A

hypogonadism
Adrenal insufficiency
Hyperalgesia

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16
Q

What is hypogonadism?

A

Diminished production of sex hormones so leads to reduced fertility, amenorrhoea, erectile dysfunction

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17
Q

What is Hyperalgesia?

A

Enhanced sensitivity to pain

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18
Q

Opioid side effects?

A 
MORPHINE
M=mitosis (Pinpoint pupils), muscle rigidity
O=out of it (sedation)
R=Respiratory depression
P=postural hypotention
H=Hyperalgesia, hallucinations
I=in frequency (urinary retention, constipation)
N=N&V
E=euphoria
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19
Q

Cautionary and advisory label of Opioids?

A

Warning. This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol

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20
Q

What opioid can be used to manage coughs in palliative care?

A

Morphine.

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21
Q

Maximum dose increments of morphine?

A

1/3 or 1/2 of total daily dose per 24hrs

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22
Q

Advantage of diamorphine over morphien?

A

Preferred over morphien when administering parenterally
As diamorphine is more soluble and smaller volumes cab be injected in emaciated pts jn palliative care

Less nausea and hypotention than morphien

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23
Q

Important pt counselling on fentanyl patches?

A

Immediately remove patch in case of breathing difficulties

24
Q

What effect does fentanyl have on blood sugar level?

A

Hyperglycaemia

25
Q

Side effect of IV fentanyl?

A

Muscle rigidity

Give slowly or avoid

26
Q

Codeine and dihydrocodeine route of injection administration?

A

Intramuscular

Never give intravenously as severe reaction similar to anaphylaxis

27
Q

MHRA advice on dihydrocodeine?

A

Prescribe and dispense by strength to minimise risk of medication error and risk of accidental overdose

28
Q

MoA of Tramadol?

A

Inhibits norepinephrine and Serotonin reuptake

29
Q

Side effects of Tramadol?

A

Increased risk of bleeding
Lowers seizure threshold
Psychiatric reactions

30
Q

Aura signs associated with migraine?

A

Visual disturbances (flashing light, zig zag patterns blind spots)
Numbness or pins and needles starting in one hand, moves up arm before affecting face, lips and tongue
Dizzy, off balance
Difficulty speaking

31
Q

Why will absorption of simple analgesics be affected in migraines? How to counteract?

A

Because peristalsis is often reduced during an attack

Use dispersible or effervescent preps

32
Q

What NSAIDs is specifically licensed for migraine?

What other NSAIDs are licensed?

A

Tolfenamic acid

Diclofenac
Ibuprofen
Flurbiprofen

33
Q

What antiemetic can be used in migraine attacks?

A

Metoclopramide or domperidone which are prokinetic as well
Or antihistamines like buclizine
Phenothiazines like Prochlorperazine

34
Q

What is ergotamine and why are they not recommended much anymore?

A

It’s an ergot alkaloid
Causes peripheral vaso spasm so stop if any numbness or tingling of extremeties occur
Avoid in cerebrovascular and CV disease

Difficulties in absorption

35
Q

MoA of triptans?

A

Serotonin receptor agonists on cranial arteries and veins to cause vasoconstriction

36
Q

Dose of triptans?

A

One ASAP after onset followed by a second dose at least 2hts later
(4hrs if naratriptan) if migraines recurs
Do not take second dose for the same attack

37
Q

Side effects of triptans?

A

Coronary vasoconstriction
Or
Anaphylaxis

38
Q

Contra indications of triptans?

A

Heart stuff like MI, stroke, uncontrolled or severe hypertention etc

39
Q

Pt counselling on triptans?

A

Stop if intense tingling, heat, heaviness, pressure or tightness in any part of the body

40
Q

Dose frequency of ergot alkaloids?

A

Fk not repeat dose jn less than 4 days

Limited to use twice a month to avoid habituation

41
Q

What kind of pt will be offered prophylaxis of migraine treatment?

A

At least 2 attacks a month
An increasing frequency of headaches
Significant disability despite suitable treatment
Cannot take suitable treatment for the attacks

42
Q

What’s a risk factor for migraines?

A

Stress
Irregular life style like sleep pattern, lack of sleep
Chemical triggers like alcohol and nitrates

43
Q

What drugs can be used for prophylaxis of migraines?

A

BBs ( propranolol is the main. Atenolol, metoprolol, nadolol, timolol)

TCAs unlicensed
Gabapentin, Topiramate, sodium valproate

Pizotifen

Botulinum toxin type A

44
Q

What is Pizotifen? Why is its use limited?

A

An antihistamine and a Serotonin receptor antagonist
Structurally related to TCAs

May cause weight gain

45
Q

How to manage acute attacks of cluster headaches?

A

SC injection of sumatriptan

If injection is unsuitable
Sumatriptan nasal spray
Zolmitriptan nasal soray
Or
100% oxygen
46
Q

When are prophylaxis of cluster headaches considered?

A

If the attacks are frequent
Last over 3wks
Cannot be treated effectively

47
Q

What’s used for prophylaxis of cluster headaches?

A 
Verapamil
Lithium
Can add prednisolone for short term as a mono or in combo
Or
Ergotamine
48
Q

Which antiepileptcs can be given for neuropathic pain?

A

Gabapentin

Pregabalin

49
Q

If TCAs and antiepileptcs don’t work to manage neuropathic pain, what can be given?

A

Morphine and oxycodone prescribed by a specialist only
Tramadol can be prescribed until a specialist can do an assessment

Lidocaine Topical
Capsaicin 0.075% cream can be used as well but specialist as well

50
Q

Side effect of Capsaicin that may limit its use?

A

Intense burning sensation during initial treatment

51
Q

Side effect of Capsaicin that may limit its use?

A

Intense burning sensation during initial treatment

52
Q

What can be used for compression neuropathy?

A

Corticosteroid

53
Q

What is trigeminal neuralgia?

A

A sudden and severe facial pain described as electric shocks in the jaw, teeth or gums. Occurs in short unpredictable attacks

54
Q

What’s used to manage trigeminal neuralgia?

A

Carbamazepine
Phenytoin
Monitor FBC and electrolytes when high doses are given

55
Q

Whats used to manage chronic oral and facial pain?

A

TCAs

Inori Pre Reg (22 decks)

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