pain management

Question 1

which analgesic should be avoided for pain in sickle-cell disease and why

Answer 1

Pethidine hydrochloride (a strong opioid)
- it should be avoided if possible because accumulation of a neurotoxic metabolite can precipitate seizures

Question 2

what is a major drug interaction of aspirin

Answer 2

aspirin interacts with warfarin. This increases risk of bleeding as they can both cause increased risk of bleeding already on their own

Question 3

if a patient overdoses on paracetamol, how long can it take for the hepatic damage to be seen

Answer 3

can take 4-6 days to see hepatic damage

Question 4

how can you minimise gastric irritation caused by NSAIDs

Answer 4

• by taking the dose after food
• Enteric-coated preparations are available
• note enteric-coated preparations have a slow onset of action and are therefore unsuitable for single-dose analgesic use (though their prolonged action may be useful for night pain)*

Question 5

when should opioids be used

Answer 5

to relieve moderate to severe pain particularly of visceral origin

Question 6

name examples of strong opioids

Answer 6

• morphine
• buprenorphine
• Diamorphine (heroin)
• fentanyl
• Oxycodone
• Pethidine
• Tapentadol
• Tramadol

Question 7

which opioid is commonly used as second-line if morphine is not tolerated

Answer 7

Oxycodone

Question 8

what does naloxone do

Answer 8

reverse effects of opioid overdose

Question 9

which opioid is only partially reversed by naloxone

Answer 9

buprenorphine

Question 10

name examples of weak opioids

Answer 10

Codeine phosphate
Dihydrocodeine
Meptazinol

Question 11

which opioids are not recommended for Postoperative analgesia

Answer 11

• buprenorphine (may antagonise the analgesic effect of previously administered opioids)
• Pethidine (because it is metabolised to norpethidine which may accumulate, particularly in renal impairment;. accumulation causes convulsions)

Question 12

what are the common side effects of opioids

Answer 12

• respiratory depression
• constipation
• nausea + vomiting
• dry mouth
• urinary retention

Question 13

why must you avoid co-prescribing opioids and benzodiazepines

Answer 13

because it causes an increased risk of sedation, respiratory depression, coma, and death

• only co-prescribe if no other alternatives available and at the lowest dose for shortest duration

Question 14

what are the contraindications for all opioids

Answer 14

• acute respiratory depression
• head injury (opioid analgesics interfere with pupillary responses vital for neurological assessment)
• raised intracranial pressure (opioid analgesics interfere with pupillary responses vital for neurological assessment)
• risk of paralytic ileus (when the muscles that move food down your throat are paralysed)