Pain and analgesia 2

Question 1

Coxibs
- ? selective inhibitors, eg ?
licensed for use in ?/?, but risk of serious adverse ? events
first line in - ? patients, or high risk of ? ? complx
? should still be co-prescribed

Answer 1

cox2
celecoxib
ra/oa
cardiac
thrombocytopenic
upper GI
ppis

Question 2

Opiates - decrease ?
not very good for ? pain
SE - ? depression, ? + ? (40%, goes upon repeat admission), ?, sedation/depression of the ? reflex, ? ? contraction (CI in ? ? disease)

Answer 2

neuro-excitability
neuropathic
resp
n+v
constipation
cough
gall bladder, gall stone

Question 3

Opiates - absolute CIs? 4

Answer 3

acute resp depression, acute alcoholism, risk of paralytic ileus, raised ICP (pupil responses)

Question 4

Opiates - tramadol has ? effects - can result in ? syndrome if used with other ? drugs
-tolerance develops within ?, physical ? may occur

Answer 4

MAOI
serotonin
serotonergic
few days
dependence

Question 5

Opiates - prescribing

• acute setting - ?mg ? morphine in healthy adults is OK, with this dose then ? upwards - start point in ?/? patients-> ?mg
• ? is usually co prescribed as anti-? of choice - ?mg IV/PO up to ?ds
• long term opioids? - co prescribed ?+?
• weak ops have ? strength opioid SE’s so again ? and ? should be co prescribed

Answer 5

5 IV 
titrated
frail/elderly
2
metoclopramide
emetic
10
tds
lactulose and senna
full
antiemetic and laxative

Question 6

Opiates - dose conversion

• convert all doses into ? ? equivalence - with BNF conversion table - and total the ? dose
• divide into two ? ? release doses of ?
• always prescribe ?th of total daily dose ? oramorph for ? pain (max ? hourly)

Answer 6

oral morphine
24h
12h modified, zomorph
1/6
prn
breakthrough

Question 7

Opiates - OD
resp depression (in over 12's) give ?
no response after 1 minute - ?
if no response at 2 mins - ?
then give ?mg/?mg doses in severely poisoned patients

Answer 7

400 micrograms IV naloxone
further 800
further 800
2mg/4mg

Question 8

Patient controlled analgesia

• main indications = ? or in ?
• shown to increase patient ? and ? overall doses used
• analgesic boluses given via ? pump and dedicated ? line, which then ? out for a set time

Answer 8

postop, onc
satisfaction, decrease
syringe
IV
locks

Question 9

Non- drug analgesia

• ? - v effective in trauma
• ? therapy - v effective around ? post op
• TENS - e current applied via ?-? generator to activate ? fibres in tissues below
• ? - can be effective in some conditions
• ???

Answer 9

splinting
cold, joints
hand held
nerve
acupuncture
CBT