Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

A13THP @ UoN > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Define Pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two broad distinctions of pain?

A

Acute

Chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the four distinctions of chronic pain?

A

Nociceptive
Neuropathic
Visceral
Mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the two distinctions of neuropathic pain?

A

Central

Peripheral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Give examples of acute pain

A

Trauma

Post-op flare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give examples of nociceptive pain

A

Osteoarthritis

Rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give examples of central neuropathic pain

A 
Post-stroke
MS
Spinal cord injury
Migraine
HIV related neuropathic pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give examples of peripheral neuropathic pain

A

Post-hepatic neuralgia

Diabetic neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give examples of visceral pain

A

Internal organ pain
Pancreatitis
IBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give examples of mixed pain

A

Lower back pain
Cancer
Fibromyalgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the goals of pain management?

A

Minimise stress response/neuroendocrine effects
Minimise adverse effects on wider systems
Patient comfort and satisfaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the three stages of the WHO pain ladder?

A

Step 1 - simple analgesics (aspirin/paracetamol)
Step 2 - opioids (mod pain) + simple analgesics
Step 3 - opioids (sev pain) + simple analgesics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does Paracetamol work?

A

MoA uncertain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the two main actions of Paracetamol?

A

Analgesia

Antipyretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What formulations is Paracetamol available in?

A 
Tablets (+ soluble)
Capsules
Suspension
Suppository
Infusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the major problems with Paracetamol?

A

Side effects uncommon

Overdose common - liver damage (14 tabs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment for Paracetamol overdose?

A

Acetylcysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do NSAIDs work?

A

Inhibit COX - prevent formation of prostaglandins/thromboxanes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the three main actions of NSAIDs?

A

Analgesia
Antipyretic
Anti-inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What formulations are NSAIDs available in?

A 
Tablets (+ soluble)
Capsules
Suspension
Suppository
Creams
Gel
Patch
Infusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the major GI adverse effects of NSAIDs?

A

GIT erosion & ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the major renal adverse effects of NSAIDs?

A

Reduce renal blood flow - acute failure

Na/K/H2O retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the major respiratory adverse effects of NSAIDs?

A

Bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the major haematological adverse effects of NSAIDs?

A

Reduce platelet aggregation

  • Aspirin irreversible
  • NSAIDs reversible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How should NSAIDs generally be used?

A

Lowest effective dose
Shortest period of time possible
Co-prescription of a PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the clinically common weak opioids?

A

Codeine
Dihydrocodeine
Dextropropoxyphene
Tramadol (po)

27
Q

What are the clinically common strong opioids?

A 
Morphine
Diamorphine
Oxycodone
Buprenorphine
Fentanyl
28
Q

When are weak opioids most effective?

A

When used in combination with paracetamol

29
Q

What CYP450 protein is responsible for the metabolism of Codeine-Morphine?

A

CYP450 2D6

30
Q

What populations are unable to metabolise Codeine-Morphine?

A

10% caucasian

90% chinese

31
Q

When are strong opioids used?

A

Acute pain
Persistent non-cancer pain
Palliative care

32
Q

What is the ceiling effect?

A

The point at which increasing dose does not increase analgesia

33
Q

What type of painkiller does not have a ceiling effect?

A

Strong opioids

34
Q

What routes of administration are available for strong opioids?

A 
Oral
Rectal
Transdermal
Sublingual
Topical
Intramuscular
Subcutaneous
Intravenous
Epidural
Intrathecal
35
Q

What are the major adverse effects of opioids?

A 
Nausea & Vomiting
Constipation
Sedation
Respiratory depression
Hypotension
Urinary retention
36
Q

What are the three steps taken when initiating morphine treatment?

A

Pain assessment
Determine opioid requirement
Convert daily dose to MR formulation

37
Q

What is breakthrough pain?

A

Transient exacerbation/recurrence of pain in a mainly stable patient

38
Q

When does breakthrough pain commonly occur?

A

End of dose failure
Incident pain
Spontaneous, unpredictable pain

39
Q

How do you control breakthrough pain?

A

Add 10% total daily regular dose prn

40
Q

Describe the treatment structure with i.m. opioids

A

4 hourly
Several doses to achieve adequate levels
Variable absorption
Painful

41
Q

What is the preferred drug for Patient Controlled Analgesia?

A

Morphine i.v.

42
Q

What drugs can be prescribed for PCA if the patient has an allergy to Morphine?

A

Tramadol
Oxycodone
Fentanyl

43
Q

What are the advantages of PCA?

A 
Rapid analgesia
Ready prepared
Patient satisfaction
No dose delay
No peaks/troughs
44
Q

What are the disadvantages of PCA?

A

Expensive
i.v.
Training
Monitoring

45
Q

Describe epidural opioids

A

Alternative to PCA

Mixture of local anaesthetic and opioid

46
Q

What are the major adverse effects of epidural opioids?

A

Hypotension
Infection
‘wrong route’

47
Q

What is the most common epidural opioid preperation?

A

Fentanyl w/ (levo)bupivicaine

48
Q

Describe syringe drivers

A

Continuous subcutaneous infections

49
Q

When are syringe drivers indicated?

A

Unable to take medicines by mouth

Bowel obstruction

50
Q

What is the most common opioid used in syringe drivers, and why?

A

Diamorphine

Excellent aqueous solubility

51
Q

What parameters should be monitored when treating with opioid?

A 
Pulse
BP
Resp rate
Ox saturation
Pain intensity
Sedation score
Opioid usage/side effects
52
Q

How does Tramadol work?

A

u agonist

Inhibits NA uptake/5-HT

53
Q

What is the side effect profile of Tramadol?

A

Less opioid side effects

Nausea/hallucinations

54
Q

How is Tramadol absorbed?

A

70% absorbed po

Peak 2 hrs

55
Q

How does Naloxone work?

A

Opioid antagonist –> reverses effects of opioids

56
Q

How should Naloxone treatment be structured?

A

Repeated doses given i.v. (short half life)
Gradual titration
-May induce pain

57
Q

What is the typical cause of neuropathic pain?

A

Damage/lesion somewhere between a peripheral nerve and the brain

58
Q

What are the symptoms of neuropathic pain?

A 
Burning
Electric shock
Pins/needles
Scalding
Shooting
Stabbing
59
Q

What are the signs of neuropathic pain?

A

Continous pain
Evoked pain
-Hyperalgesia
-Allodynia

60
Q

What are the pharmacological treatments for neuropathic pain?

A 
TCAs
Anticonvulsants
Opioids
Local anaesthetics
Capsaicin
61
Q

How do TCAs work?

A

Inhibit NA/serotonin reuptake

62
Q

What limits the use of TCAs?

A

Widespread adverse effects

63
Q

What are the two most clinically common anticonvulsants?

A

Gabapentin

Pregabalin

64
Q

How do anticonvulsants work?

A

Prevent voltage dependent Ca channel activation in dorsal horn neurones

A13THP @ UoN (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions