Pain Management Flashcards

1
Q

What is Step 1 in the WHO pain ladder?

A

Non-opioid analgesia ± adjuvants

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2
Q

What is Step 2 in the WHO pain ladder?

A

Weak opioid analgesia + non-opioid analgesia ± adjuvants

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3
Q

What is Step 3 in the WHO pain ladder?

A

Strong opioid analgesia + non-opioid analgesia ± adjuvants

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4
Q

Give an example of a non-opioid analgesic agent and an appropriate dose

A

Paracetamol 1g QDS po

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5
Q

Give 3 examples of weak opioid analgesic agents used for the management of pain

A

Co-codamol 30/500
Co-dydramol
Tramadol

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6
Q

What are the components of co-codamol 30/500?

A

Codeine 30mg

Paracetamol 500mg

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7
Q

What are the components of co-dydramol?

A

Dihydrocodeine

Paracetamol

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8
Q

Give examples of strong opioid analgesic agents

A
Morphine
Oxycodone
Fentanyl
Diamorphine
Buprenorphine
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9
Q

List some adjuvant analgesics which can be used alongside the steps of the WHO pain ladder

A
NSAIDs e.g. ibuprofen
Tricyclics e.g. amitriptyline
Gabapentin
Bisphosphonates
Steroids
Radiotherapy
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10
Q

What are the names (drug name and trade name) of the short-acting and the long-acting preparations for morphine?

A
Short-acting = Oral morphine sulphate solution (Oramorph)
Long-acting = Morphine sulphate slow release tablets (MST Continus)
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11
Q

True / False: It is acceptable to use the trade name for morphine when prescribing

A

True - You can write ‘Oramorph’ on the prescription

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12
Q

How long does Oramorph last for?

A

4 hours

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13
Q

How many doses of long-acting morphine (morphine sulphate slow release tablets) are given daily?

A

2 doses - one in the morning and one in the evening

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14
Q

What is the trade name for the short-acting morphine TABLETS which are available?

A

Sevredol

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15
Q

What dose of Oramorph would you start someone on?

A

Usually 10mg - If they have been on regular Step 2 analgesia they have already shown they can cope with opioids so this is appropriate. Consider lower dose in people with risk factors.

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16
Q

How frequently would you prescribe Oramorph?

A

Every 4 hours

17
Q

How do you work out the dose of long-acting morphine (MST Continus) to give?

A

Add up the total dose of short-acting Oramorph the patient is taking in one day and divide this into 2 equal doses. For example, if patient is on 10mg of Oramorph 4hrly (6 times per day) they take 60mg of morphine. 60/2 = 30 so the dose of MST Continus is 30mg twice a day (one in the morning and one in the evening)

18
Q

What might you consider prescribing alongside morphine to reduce the effects of a particular side effect?

A

Anti-emetic - Morphine commonly causes nausea and vomiting

Metoclopromide 10mg TDS po or s/c

19
Q

Can you give ‘breakthrough’ morphine to a patient already on long-acting MST Continus?

20
Q

What would be your choice of breakthrough analgesia for a patient who is already on long-acting MST Continus?

A

Oramorph (a short-acting morphine preparation)

21
Q

How would you work out the dose of breakthrough morphine required for a patient who is daily long-acting MST Continus if they needed extra analgesia for acute pain?

A

Total daily dose of morphine divided by 6 e.g. if patient is on 60mg of MST Continus daily (split into 2x 30mg doses), then you can prescribe 60/6 = 10mg of Oramorph as breakthrough medication

22
Q

What is the dosing instruction for PRN ‘breakthrough’ morphine?

A

Max. 2 doses every 4 hours or 6 doses per 24 hours

23
Q

What does of codeine is in the standard dose of co-codamol which is prescribed?

A

30mg (Co-codamol is usually 30/500)

24
Q

How long does it take for the effects of a morphine patch to wear off?

A

12-18 hours

25
If switching from MST Continus BD to Fentanyl patches, how much overlap should there be between the 2 medications?
Take the final tablet of MST Continus at the same time as applying the Fentanyl patch
26
Tramadol 100mg is equivalent to what dose of oral morphine sulphate?
20mg (conversion is 5:1)
27
What must be included on a prescription for a controlled drug?
- Prescriber details: Signature, date, prescriber address - Patient full name, DOB and address - The name and form of the drug e.g. morphine sulphate tablets - The dose (e.g. 40mg) or strength (e.g. 10mg/5mL) of the drug - The total quantity or total number of units written in words and figures
28
How would you write an outpatient prescription of Morphine Sulphate Tablets (MST) 40mg PO BD?
``` Morphine sulphate tablets (MST) 40mg PO BD Supply 20 (twenty) 10mg tablets and 20 (twenty) 30mg tablets ```
29
What dose of MST Continus is NOT available?
Tablets don't come in 20mg
30
List some side effects of NSAIDs
``` Fluid retention, hypertension Heart failure Bleeding GI disturbance - Ulcers, dyspepsia, nausea and vomiting Nephrotoxocity and renal failure Bronchospasm ```