Pain management Flashcards

1
Q

Outline the steps in the WHO pain ladder

A
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2
Q

What are the considerations in paracetamol dosing in children

A

Oral admin: Check which 2 year age band they fall into. Prescribe in mg NOT ml
IV: Use dosing table. Only 50ml vial if 33kg or under

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3
Q

Outline the paracetamol doses for adults

A

Oral: 4g in 24 hours
- Less if under 50kg, overweight don’t need increases

IV: 3g in 24 hours
- 4hrs between admin, 6 if renal impairment

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4
Q

What are examples of COX-1 and COX-2 inhibitors

A

COX-1: Ibuprofen, diclofenac
COX-2: -Coxibs

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5
Q

What are the risks with NSAIDs

A

GI irritation, bleeds
Increased cardiac events (diclofenac, high dose ibuprofen)

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6
Q

What meds need reviewed when starting an NSAID?

A

Start PPI, Review/stop anticoagulants

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7
Q

Which conditions need considered in NSAID prescription?

A

Asthma
Liver impairment
Renal impairment

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8
Q

What is the dosage of aspirin

A

300-900mg 4-6 hourly
450-900mg 4 hourly if rectal

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9
Q

What dose of the following drugs is equivalent to 10mg MST:

Hydromorphone
Diamorphine
IV/IM/SC morphine
Oxycodone
Codeine
Tramadol
Dihydrocodone

A

Hydromorphone: 2mg

Diamorphine: 3mg

IV/IM/SC morphine: 5mg

Oxycodone: 6.6mg

Codeine/ Tramadol/ Dihydrocodone: 100mg

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10
Q

Adverse effects of weak opioids

A

Constipation
Drowsiness

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11
Q

What route of codeine admin causes anaphylaxis?

A

IV

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12
Q

How is codeine metabolised?

A

Liver via P450

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13
Q

What are the difficulties in converting tramadol to morphine?

A

Acts on multiple opioid receptors + serotonin/noradrenaline
Ranges from 1:10 to 1:6 the morphine dose

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14
Q

What are the advantages and disadvantages of tramadol

A

Advantages:
- Less GI risk, constipation, resp depression
- Chronic and neuropathic pain

Disadvantages:
- Nausea and vomiting
- Affects seizure threshold
- Some patients have no response

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15
Q

List 3 strong opioids

A

Morphine
Diamorphine
Oxycodone
Fentanyl
Buprenoprhine
Methadone

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16
Q

What adjuvant analgesics can be used

A

Antidepressants: TCAs (~1/10th psychiatric dose) + SSRIs
Anticonvulsants: Carbamazepine, Gabapentin, Lamotrigene, Pregabalin
NMDA receptor antagonists: Ket, Mg2+

17
Q

What is the typical dosing regimen for…
Amitiptyline
Duloxetine
Gabapentin
Pregabalin

A

Amitiptyline: 10mg nightly, up to 75mg
Duloxetine: 60mg daily, up to 120mg
Gabapentin: specialist
Pregabalin: 150mg over 2-3 doses, up to 600mg

18
Q

What are the features of local anaesthetic toxicity?
What drug can be considered in its reversal?

A

Mild: Visual changes, paraesthesia
Mod: Reduced GCS, convulsions
Fatal: Acute cardio-resp arrest

Intralipid