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Pharmacy > Pain management > Flashcards

Pain management Flashcards

1
Q

What is nociceptive pain?

A

Organ/Tissue release prostaglandins –> inflammation & lowering of pain threshold

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2
Q

What is neuropathic pain?

A

Pain due to nerve damage

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3
Q

What are the classes of analgesics

A
  1. NSAIDs
  2. paracetamol
  3. opioids
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4
Q

The types of paracetamol products

A
  1. paracetamol 500mg tab
  2. paracetamol 120mg/5mL syrup
  3. paracetamol 125mg suppository
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5
Q

MOA of paracetamol

A
  1. anti-pyretic
  2. reduce the production of prostaglandins
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6
Q

Dosing & Min age of paracetamol

A

Min Age: 3 yo
Tablet: 500-1g QDS (max: 4g/d)
Suspension (paeds): 10-15mg/kg/dose (QDS frequency)
rectal: 625mg QDS (max 3.9g/d)

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7
Q

DDI with paracetamol

A

Blood thinners - Warfarin
if RX >5d, paracetamol dose should not exceed 2g/d

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8
Q

What are the paracetamol-combination products

A
  1. Anarex - orphenadrine + paracetamol
  2. Panadeine - Paracetamol + codeine
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9
Q

MOA, Dosing, Min Age, Forensic classification of Anarex?

A

MOA: orphenadrine as a muscle relaxant
Use: mild-mod pain, temporary relieve of fever
min age: 12yo
dose: 2 tablets TDS PRN
POM

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10
Q

MOA, dosing, min age,forensic classification of panadiene

A

MOA: contains opioid, mainly to help reduce the pain (only given when other analgesics fail)
Dosing: 1-2 tablet QDS (max: 4g/d of panadol)
Min age: 12yo
P-only

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11
Q

Counselling points and side effects for Anarex

A
  • may cause drowsiness. if so dont operate machinery or drive
  • do not take other paracetamol containing products
  • SE: constipation, dry mouth, dry eye, dry skin, urinary retention, stomach discomfort
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12
Q

Counselling points & side effects for Panadeine

A
  • may cause drowsiness. if so dont operate machinery or drive
  • do not take other paracetamol containing products
  • SE: constipation, respiratory depression
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13
Q

What does non-selective NSAIDs mean? (MOA)

A

Inhibits both Cox 1 & cox 2 enzyme - reduce prostaglandins

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14
Q

Give some examples of non-selective NSAIDs

A
  • ibuprofen
  • mefanemic acid
  • ketoprofen
  • diclofenac
  • naproxen
  • meloxicam
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15
Q

What does selective NSAIDs mean? (MOA)

A

they inhibit the Cox-2 enzyme only

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16
Q

Give some examples of Selective NSAID

A
  • etoricoxib
  • celecoxib
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17
Q

Side effects of NSAIDs

A

GIT - stomach discomfort, gastric bleeding
Asthma - bronchospasm may occur (for non-selective)
Renal - rare - worsening function, fluid retention
CVS - increase risk of stroke/heart attack (for selective)

18
Q

contraindication of NSAIDs

A

active bleeding
severe kidney impairment (<30ml/min)
third trimester in pregnancy
uncontrolled HF

19
Q

DDI with NSAIDs

A

avoid >1 week if on blood thinners

20
Q

why GI side effects more common for non-selective than selective NSAIDs

A

cox 1 is gastro protective effects (due to prostaglandins), if blocked will loose its effects
tendency of GI effects are lower for cox 2 selective
can reduce by avoiding non-selective or to give a PPI

21
Q

What is the dose & min age & forensic class for Ibuprofen

A

tablet: 200-400mg TDS
syrup: 5-10mg/kg/dose (TDS)

max: 2.4g/d
min age: 6mths
P+ / GSL

22
Q

What is the dose & min age & forensic class for Diclofenac

A

Voltaren: 25-50mg TDS
max: 150mg/d
Min age: 12yo
class: POM

23
Q

What is the dose & min age & forensic class for naproxen

A

Synflex: 275-550mg BD (2 tab bd)
min age 12 yo
class: POM

Aleve: 220mg TDS (1 tab TDS)
min age: 12yo
class: GSL

24
Q

What is the dose & min age & forensic class for Mefenamic Acid

A

Ponstan
250-500mg TDS PRN (1-2 tab TDS)
min age: 12yo
class: POM

25
Q

What is the dose & min age & forensic class for Meloxicam

A

7.5-15mg OD (1-2tab OD)
min age: 18yo
class: POM

26
Q

What is the dose & min age & forensic class for Indomethacin

A

25-50mg TDS PRN (1-2 tab TDS)
max: 200mg/d
min age: 15 yo
class: POM

27
Q

What is the dose & min age & forensic class for Celecoxib

A

200-400mg OD/BD
max: 400mg/d
min age: 18yo
class: POM

28
Q

What is the dose & min age & forensic class for etoricoxib

A

up to 120mg OD
min age: 16yo
class: POM

29
Q

Topical ketoprofen preparations ?
min age
dosing instructions

A

Fastum - min age: 6yo, BD
Kefentech - min age: 12y0, 1 plaster BD

30
Q

fastum counselling

A

not to apply on broken skin
may cause light sensitivity (until 2 weeks after you stop using the medicine)

31
Q

what does Rub-on contain

A

methyl salicylate

32
Q

what is the minimum age for Rub-on

A

6yo

33
Q

what is the difference between Kefentech Air & P-sale kefentech

A

Both have the same medication
Kefentech air - breathable & reduced skin irritation

34
Q

how do we treat fever for children

A

depends on how high the fever is
if >38.5 degree: should give ibuprofen
if <38.5 degree: to give paracetamol
check temp and administer the medication every 4hrs

(min 6hr for ibuprofen & min 4hr for paracetamol)

35
Q

When should the child see a doctor when having fever?

A
  1. fever did not subside within 72hrs
  2. look more sick n tired
  3. non-blanching rashes
  4. child having fits
36
Q

MOA of opioids

A

bind to opioid receptors in the CNS, leading to inhibition of pain

37
Q

What is the dose & min age & forensic class for codeine

A

30-60mg TDS (1-2tab TDS)
12yo
POM

38
Q

What is the dose & min age & forensic class for tramadol

A

50mg TDS (max: 400mg/d)
12yo
POM

39
Q

Side effects of opioids

A

drowsiness
constipation
nausea & vomitting (for tramadol - due to high dose)

40
Q

how do you counsel people on multiple analgesics

A
  1. paracetamol
  2. NSAIDs
  3. opioids

can take the weaker one first, if after that it didn’t help then step up

it is also not wrong to advise to take the NSAID first if the problem is inflammation/swelling

Pharmacy (5 decks)

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