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Anaesthetics > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Score 0 on acute pain analgesia scoring

A

No pain at rest

No pain on movement

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2
Q

Score 1 on acute pain analgesia scoring

A

No pain at rest

Slight pain on movement

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3
Q

Score 2 on acute pain analgesia scoring

A

Intermittent pain at rest

Moderate pain on movement

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4
Q

Score 3 on acute pain analgesia scoring

A

Continuous pain at rest

Severe pain on movement

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5
Q

Step 1 of WHO analgesic ladder:

scoring and drugs

A

Score 0-1

Paracetamol 1g 6-hourly PO/PR/IV
max 60mg/kg daily

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6
Q

Step 2 of WHO analgesic ladder:

scoring and drugs

A

Score 1-2

Paracetamol 1g 4-6 hourly

PLUS

Codeine 30-60mg 4-hourly (max 240mg/24h)
OR
Tramadol 50-100mg 4-hourly (max 600mg/24h)

+/- NSAIDs: ibuprofen 400mg 8 hourly MAX 48h then review

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7
Q

Step 3 of WHO analgesic ladder:

scoring and drugs

A

CONTINUE
Paracetamol
NSAIDs

Replace Tramadol or Codeine with:
Oramorph 
OR 
PCA Morphine 
OR 
Short duration IV/IM/SC morphine 
OR 
Regional technique e.g. epidural
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8
Q

Breakthrough analgesia:
What drug is recommended?
How is dosing calculated?

A

Oxynorm 5mg or Oramorph 10mg

Breakthrough analgesia should be 1/6th of total daily dose

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9
Q

If patient’s pain is still not controlled with Morphine what can be given

A

Oxycodone Sustained Release (Oxycontin)

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10
Q

Usual dose of Orapmorph

A

10mg/5mls

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11
Q

How can IV morphine be used as ‘rescue analgesia’

A

given as 2mg boluses every 5 mins up to 10mg

in elderly or frail - 1mg boluses

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12
Q

Where should IV morphine be written on the Kardex

A

PRN or Once Only section

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13
Q

Compare the potency of Tramadol and Morphine

A

Tramadol is less potent than morphine

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14
Q

Why is IV Tramadol not used as rescue analgesia

A

Fast administration is very unpleasant for patients and can induce seizure

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15
Q

Which route is preferred for morphine: IV/SC/IM

A

IV if possible - but IM/SC has a place for short term acute pain

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16
Q

Patients on continuous morphine infusion - where should they be cared for

A

HDU or ICU with level 1 care

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17
Q

What patients are suitable for continuous morphine infusion

A

patients on long term opioid therapy who are unable to take their regular strong opioids

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18
Q

standard UK dose of PCA morphine

A

1mg morphine bolus, with 5 min lockout

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19
Q

Combining opioids whilst on PCA morphine - advised/not advised?

A

NOT ADVISED - must not be on any other opioid analgesics - but will benefit from NSAIDs and paracetamol

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20
Q

If patient is receiving IV morphine, how is the dose of oral morphine calculated for step down?

A

Oral:IV = 2:1

Oral is double the dose of IV

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21
Q

Drugs commonly used in spinal opioids

A

fentanyl (lasts up to 4 hours)
diamorphine (lasts up to 12 hours)
morphine (lasts up to 24 hours)

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22
Q

Naloxone

A

opioid antagonist

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23
Q

the 3 indications for administration of Iv naloxone

A

sedation score = 3
patient has shallow resps or RR < 8/minute
patient has pinpoint pupils

24
Q

Compare the half life of naloxone to the half life of opioids

A

Naloxone is SHORTER than opioids.

Naloxone may have to be repeated after 20-30 minutes

25
Q

Side effects of morphine

A

Nausea and vomiting (can give anti-emetics)
Constipation (Senna)
Itch (often given with antihistamines)

26
Q

Assessment and scoring system for N+V

A 
0 = none 
1 = mild (nausea only) 
2 = moderate (vomited once) 
3 = severe (vomited more than once)
27
Q

4 groups of anti-emetic drugs

A

5HT3 antagonists
Antihistamines
Antidopaminergics
Anticholinergics

28
Q

5HT3 antagonists

A

anti-emetic

Ondansetron, Granisetron

29
Q

Antihistamine used for anti-emetic

A

Cyclizine

30
Q

Antidopaminergic used as anti-emetic

A

Prochlorperazine

Metoclopramide

31
Q

Anticholinergic used as anti-emetic

A

Hyoscine

32
Q

Anti-emetic associated with QT prolongation

A

Ondansetron

33
Q

Anti-emetic that causes extrapyramidal symptoms

A

Prochlorperazine

34
Q

Antiemetic with limited value in opioid induced vomiting

A

Metoclopramide

35
Q

Benefit of an epidural anaesthesia

A

targeted at the area of the body where the pain is

36
Q

5 potentially catastrophic complications of an epidural

A
  1. permanent nerve damage
  2. intravascular injection
  3. complete spinal injection
  4. epidural abscess
  5. epidural haematoma
37
Q

What is nociceptive pain

A

Physiological pain

38
Q

What is neuropathic pain

A

Pathological pain - arises from some fault or change in the nervous system.

39
Q

Drugs used in neuropathic pain

A

TCAs -amitriptylline

Anticonvulsants - Gabapentin, (Pregabalin - use after other 2)

40
Q

what changes happen to the nervous system to cause neuropathic pain

A

amplification of signals in the dorsal horn (central sensitisation)
increased number of nociceptors in the periphery
cross connections in the nerve
loss of descending inhibition

41
Q

examples of NSAIDS and mechanism of action of NSAIDs

A

ibuprofen, diclofenac, naproxen

classified by whether they block COX1, COX2 or both
above are non-specific

42
Q

why do NSAIDs cause AKI

A

block production of prostaglandins (anti-inflammatory effect)

however prostaglandins dilate the renal arterioles

43
Q

Timings of acute and chronic pain

A

acute < 3 months

chronic > 3 months

44
Q

How does Lidocaine work

A

Local anesthetic that blocks Na+ channels

Therefore the neurones cannot depolarise

45
Q

Paracetamol mechanism of action

A

Unclear

?COX3 inhibitory effect

46
Q

NSAIDs mechanism of action

A

anti-inflammatory analgesics by blocking prostaglandin production

47
Q

what functions do prostaglandins play a role in

A

gastric mucosal production
renal function
bronchodilation
platelet adhesiveness

48
Q

locations of opioid receptors in the body

A 
CNS 
pituitary 
GI system 
Periacqueductal grey 
dorsal horn of the spinal cord
49
Q

How do pain signals travel from the periphery to the spinal cord

A

Nociceptors

50
Q

Pain neurotransmitters

A

ATP
Glutamate
Substance P

51
Q

3 main classes of opioid receptor

A

mu, kappa, delta

52
Q

Tramadol mechanism of action

A

binds weakly to mu opioid receptors

inhibits noradrenaline reuptake

53
Q

Mechanism of action of codeine

A

Codeine itself doesn’t have any opioid action

it is metabolised to morphine

54
Q

Morphine mechanism of action

A

potent mu opioid agonist

55
Q

Analgesic ratio of Oxycodone and morphine

A

Oxycodone has a higher bioavailability than morphine

Ratio of approx 1:2

Oxycodone SR 10mg = MST 20mg
Oxycodone immediate release 5mg = Oramorph 10mg

56
Q

What is Fentanyl

A

short-acting and faster onset duration opioid than morphine

Anaesthetics (2 decks)

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