Pain management Flashcards
What is nociceptive pain?
Organ/Tissue release prostaglandins –> inflammation & lowering of pain threshold
What is neuropathic pain?
Pain due to nerve damage
What are the classes of analgesics
- NSAIDs
- paracetamol
- opioids
The types of paracetamol products
- paracetamol 500mg tab
- paracetamol 120mg/5mL syrup
- paracetamol 125mg suppository
MOA of paracetamol
- anti-pyretic
- reduce the production of prostaglandins
Dosing & Min age of paracetamol
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)
DDI with paracetamol
Blood thinners - Warfarin
if RX >5d, paracetamol dose should not exceed 2g/d
What are the paracetamol-combination products
- Anarex - orphenadrine + paracetamol
- Panadeine - Paracetamol + codeine
MOA, Dosing, Min Age, Forensic classification of Anarex?
MOA: orphenadrine as a muscle relaxant
Use: mild-mod pain, temporary relieve of fever
min age: 12yo
dose: 2 tablets TDS PRN
POM
MOA, dosing, min age,forensic classification of panadiene
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
Counselling points and side effects for Anarex
- 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
Counselling points & side effects for Panadeine
- may cause drowsiness. if so dont operate machinery or drive
- do not take other paracetamol containing products
- SE: constipation, respiratory depression
What does non-selective NSAIDs mean? (MOA)
Inhibits both Cox 1 & cox 2 enzyme - reduce prostaglandins
Give some examples of non-selective NSAIDs
- ibuprofen
- mefanemic acid
- ketoprofen
- diclofenac
- naproxen
- meloxicam
What does selective NSAIDs mean? (MOA)
they inhibit the Cox-2 enzyme only
Give some examples of Selective NSAID
- etoricoxib
- celecoxib
Side effects of NSAIDs
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)
contraindication of NSAIDs
active bleeding
severe kidney impairment (<30ml/min)
third trimester in pregnancy
uncontrolled HF
DDI with NSAIDs
avoid >1 week if on blood thinners
why GI side effects more common for non-selective than selective NSAIDs
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
What is the dose & min age & forensic class for Ibuprofen
tablet: 200-400mg TDS
syrup: 5-10mg/kg/dose (TDS)
max: 2.4g/d
min age: 6mths
P+ / GSL
What is the dose & min age & forensic class for Diclofenac
Voltaren: 25-50mg TDS
max: 150mg/d
Min age: 12yo
class: POM
What is the dose & min age & forensic class for naproxen
Synflex: 275-550mg BD (2 tab bd)
min age 12 yo
class: POM
Aleve: 220mg TDS (1 tab TDS)
min age: 12yo
class: GSL
What is the dose & min age & forensic class for Mefenamic Acid
Ponstan
250-500mg TDS PRN (1-2 tab TDS)
min age: 12yo
class: POM
What is the dose & min age & forensic class for Meloxicam
7.5-15mg OD (1-2tab OD)
min age: 18yo
class: POM
What is the dose & min age & forensic class for Indomethacin
25-50mg TDS PRN (1-2 tab TDS)
max: 200mg/d
min age: 15 yo
class: POM
What is the dose & min age & forensic class for Celecoxib
200-400mg OD/BD
max: 400mg/d
min age: 18yo
class: POM
What is the dose & min age & forensic class for etoricoxib
up to 120mg OD
min age: 16yo
class: POM
Topical ketoprofen preparations ?
min age
dosing instructions
Fastum - min age: 6yo, BD
Kefentech - min age: 12y0, 1 plaster BD
fastum counselling
not to apply on broken skin
may cause light sensitivity (until 2 weeks after you stop using the medicine)
what does Rub-on contain
methyl salicylate
what is the minimum age for Rub-on
6yo
what is the difference between Kefentech Air & P-sale kefentech
Both have the same medication
Kefentech air - breathable & reduced skin irritation
how do we treat fever for children
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)
When should the child see a doctor when having fever?
- fever did not subside within 72hrs
- look more sick n tired
- non-blanching rashes
- child having fits
MOA of opioids
bind to opioid receptors in the CNS, leading to inhibition of pain
What is the dose & min age & forensic class for codeine
30-60mg TDS (1-2tab TDS)
12yo
POM
What is the dose & min age & forensic class for tramadol
50mg TDS (max: 400mg/d)
12yo
POM
Side effects of opioids
drowsiness
constipation
nausea & vomitting (for tramadol - due to high dose)
how do you counsel people on multiple analgesics
- paracetamol
- NSAIDs
- 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
