Pain CBL Flashcards

1
Q

What is the advantage of a pain relief gel?

A

Works locally and does not cause systemic side effects

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2
Q

What are the counselling points for topical capsaicin?

A
  • Avoid contact with broken skin
  • It will burn when you first apply it. They have to take the dose regularly otherwise when they next apply it, it will start burning again. It releases substance P at the nerve terminal preventing electrical impulse transmission (burning sensation)
  • Wash your hands after gel
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3
Q

Can opioid patches be cut in half?

A

No - half of the patch won’t have the adhesion preventing the drug from being absorbed into the subcutaneous layer.

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4
Q

How would you find out what strength analgesic patches a patient is on?

A
  • Ask her
  • Look at the patch as it will be marked
  • Summary care records
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5
Q

A patient wants to use 3 Bupeaze batches as a dose. What would you say?

A

BNF states you cannot use more than 2 patches at once.

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6
Q

What pain relief patches can be cut in half?

A

Lidocaine

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7
Q

What are the counselling points for opioid pain relief patches?

A
  • Max 2 at any one time regardless of strength
  • Apply to non-irritated, clean skin on a non hairy flat surface (no scars)
  • Apple immediately after removal from the sachet and press down for 30 seconds
  • Won’t be affected when showering, can be worn up to 4 days
  • Drowsiness- driving
  • When applying another patch, it should be applied to a different skin site (1 week break on that area of skin)
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8
Q

What are the prescribing requirements for an opioid patch as well as the normal prescribing requirements?

A
  • Quantity in words and figures
  • CD2 drug
  • Can either write the number of patches e.g. “four patches” or just the total dose e.g. “80 micrograms” all together
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9
Q

What questions would you ask a patient before they start an NSAID/COXIB

A
  • Allergies/previous ADR
  • Tried any before? Are they on paracetamol?
  • Any comorbidities? NSAIDs can raise BP - the more comorbidities, the higher the GI risk
  • PMH of stomach ulcers/bleeds/asthma?
  • On any medication that increases bleeding risk e.g. aspirin?
  • Renal/hepatic impairments?
  • PMH of cardiac events?
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10
Q

What do you have to keep in mind with a patient who has hypertension and on 1) an NSAID or 2) COXIB?

A
  1. NSAIDs can raise BP

2. Although coxibs can increase risk of cardiac events, her hypertension should be well managed with current medication

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11
Q

Based on relative side effect risks, what NSAID would you recommend?

A
  • Risk/benefit balance
  • Has she tried any before? Has she been on the max dose?
  • Ibuprofen has the lowest GI side effects
  • Naproxen has the lowest cardiac side effects (however max OTC ibuprofen also has lowest cardiac side effects)
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12
Q

Osteoarthritis is an inflammatory condition. True or false?

A

False- it is worn out joints

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13
Q

Rheumatoid arthritis is an inflammatory condition. True or false?

A

True

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14
Q

What alternative to NSAID could you consider? What are the risks?

A
  • COX selective inhibitor -coxib
  • Low GI risk
  • Has cardiac side effects leading to one of them being taken off the market
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15
Q

What is a side effect of diclofenac?

A

Cardiovascular side effects e.g. MI and stroke

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16
Q

When would a PPI be suitable with a person taking NSAID?

A
  • Taking it for a long term condition

- PMH of bleeding, GI problems

17
Q

During a pain consultation, what questions should you ask?

A
  • Rate pain on a scale
  • How often do you use PRN analgesics and do they work?
  • Adherence to regular analgesics
  • Side effects to pain medication
  • What makes the pain worse? any patterns e.g. walking, lying down
18
Q
  1. What is the ratio to oxycodone to morphine in terms of morphine equivalence?
  2. What is the difference between morphine and oxycodone?
A
  1. Oxycodone has double the amount of morphine equivalence
  2. Morphine has an active metabolite that is more potent so builds up in the blood, and oxycodone does not have active metabolites so after it is broken down it is non-active and excreted
19
Q

Generally morphine is preferred over oxycodone as it has less morphine equivalent. In what situation would oxycodone be preferred?

A

Renal impairment

20
Q

If on a lot of pain medication, what order would you want a patient to stop taking pain medication in?

A

In order of strongest to weakest (down the pain ladder)

If someone is on an opiate they should still be on paracetamol or NSAID as they are opiate sparing (reduces need for opiate)

21
Q

How would you step down MR oxycodone? How would you explain to the patient?

A
  • Taper dose gradually to prevent withdrawal symptoms
  • In 5mg at a time
  • Written and explained instructions on how to step down on their own painkillers
  • Give yourself a day or so on the original dose and if you feel comfortable/do not need any breakthrough (PRN) doses, try and step down for a few days
  • If you feel like you are in pain when you step down, can increase again and then try again in a few days
  • The patient will know what kind of pain they are in