Pain Management

Question 1

Adverse effects of NSAIDS

Answer 1

GI side effects due to inhibition (COX-1) of prostaglandins providing homeostasis for stomach lining

Renal- prostanoid inhibition

Reduced/increase platelet aggregation

Drug interactions

Hypersensitivity and cross sensitivity

Question 2

Name some risk factors that would warrant PPI in NSAID precription

Answer 2

Age >65 years

Previous history of peptic ulcer

Previous upper GI bleeding

Dyspepsia
Oral anticoagulant therapy including NOACs

Long term NSAID use for OA and RA

Excessive alcohol consumption

Corticosteroid treatment

Treatment dose of heparin and LMWH

Concomitant medication known to increase the risk of a GI event eg. SSRIs, bisphosphonates

Question 3

Name a weak opioid

and dose

Answer 3

Dihydrocodeine

30mg every 4-6hours

Question 4

Why is weak opoid preferred?

Answer 4

Variations in metabolism
Codeine-pro-drug converted to morphine (CYP450 - CYP2D6)
Non-metabolisers (1in 10 Caucasians)
Ultra-rapid metabolisers (increased risk of side effects)
BSUH incident: death of renal patient given codeine
Dihydrocodeine first line weak opioid– metabolites less likely to accumulate

Question 5

Give 3 examples of strong opiates

Answer 5

Morphine
Oxycodone
Fentanyl

Question 6

Buprenorphine

Answer 6

partial mu-opoid receptor agonist

effective detoxifying agent for opioid dependence and is equivalent to or better than methadone