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Pain Management Flashcards

(56 cards)

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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

Study These Flashcards
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

Study These Flashcards
A

Naloxone is SHORTER than opioids.

Naloxone may have to be repeated after 20-30 minutes

25
Side effects of morphine
Nausea and vomiting (can give anti-emetics) Constipation (Senna) Itch (often given with antihistamines)
26
Assessment and scoring system for N+V
``` 0 = none 1 = mild (nausea only) 2 = moderate (vomited once) 3 = severe (vomited more than once) ```
27
4 groups of anti-emetic drugs
5HT3 antagonists Antihistamines Antidopaminergics Anticholinergics
28
5HT3 antagonists
anti-emetic | Ondansetron, Granisetron
29
Antihistamine used for anti-emetic
Cyclizine
30
Antidopaminergic used as anti-emetic
Prochlorperazine | Metoclopramide
31
Anticholinergic used as anti-emetic
Hyoscine
32
Anti-emetic associated with QT prolongation
Ondansetron
33
Anti-emetic that causes extrapyramidal symptoms
Prochlorperazine
34
Antiemetic with limited value in opioid induced vomiting
Metoclopramide
35
Benefit of an epidural anaesthesia
targeted at the area of the body where the pain is
36
5 potentially catastrophic complications of an epidural
1. permanent nerve damage 2. intravascular injection 3. complete spinal injection 4. epidural abscess 5. epidural haematoma
37
What is nociceptive pain
Physiological pain
38
What is neuropathic pain
Pathological pain - arises from some fault or change in the nervous system.
39
Drugs used in neuropathic pain
TCAs -amitriptylline | Anticonvulsants - Gabapentin, (Pregabalin - use after other 2)
40
what changes happen to the nervous system to cause neuropathic pain
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
examples of NSAIDS and mechanism of action of NSAIDs
ibuprofen, diclofenac, naproxen classified by whether they block COX1, COX2 or both above are non-specific
42
why do NSAIDs cause AKI
block production of prostaglandins (anti-inflammatory effect) however prostaglandins dilate the renal arterioles
43
Timings of acute and chronic pain
acute < 3 months | chronic > 3 months
44
How does Lidocaine work
Local anesthetic that blocks Na+ channels Therefore the neurones cannot depolarise
45
Paracetamol mechanism of action
Unclear | ?COX3 inhibitory effect
46
NSAIDs mechanism of action
anti-inflammatory analgesics by blocking prostaglandin production
47
what functions do prostaglandins play a role in
gastric mucosal production renal function bronchodilation platelet adhesiveness
48
locations of opioid receptors in the body
``` CNS pituitary GI system Periacqueductal grey dorsal horn of the spinal cord ```
49
How do pain signals travel from the periphery to the spinal cord
Nociceptors
50
Pain neurotransmitters
ATP Glutamate Substance P
51
3 main classes of opioid receptor
mu, kappa, delta
52
Tramadol mechanism of action
binds weakly to mu opioid receptors | inhibits noradrenaline reuptake
53
Mechanism of action of codeine
Codeine itself doesn't have any opioid action | it is metabolised to morphine
54
Morphine mechanism of action
potent mu opioid agonist
55
Analgesic ratio of Oxycodone and morphine
Oxycodone has a higher bioavailability than morphine Ratio of approx 1:2 Oxycodone SR 10mg = MST 20mg Oxycodone immediate release 5mg = Oramorph 10mg
56
What is Fentanyl
short-acting and faster onset duration opioid than morphine

Anaesthetics (2 decks)

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