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
