Pain / MSK

Question 1

Examples of nsaids

Answer 1

ibuprofen

naproxen

Question 2

how do NSAIDs work

Answer 2

inhibit inflammatory effect of prostaglandins by inhibiting cyclooxygenase

Question 3

when are NSAIDs used

Answer 3

mind to moderate pain

pain caused by inflammatory reactions

Question 4

when are NSAIDs contraindicated

Answer 4

renal failure
liver failure
CVS conditions
those at risk of GI bleeds, PUD

Question 5

side effects of NSAIDs

Answer 5

GI bleeds, PUD, heart problems, fluid retention, renal impairment

Question 6

possible interactions with NSAIDs

Answer 6

increase risk of PUD - aspirin, corticosteroids
increase risk of GI bleeds - anti-coags, SSRIs
increase risk of renal impairment - ACEi, diuretics

Question 7

examples of mid-moderate opioids

Answer 7

codeine

Question 8

when is codeine used

Answer 8

mild to moderate pain

Question 9

how does codeine work

Answer 9

metabolised in the liver into active morphine - morphine acts as an agonist for opioid receptors in the CNS, decreasing neuronal excitability and sympathetic response - decreases pain transmission

Question 10

contraindications of codeine

Answer 10

epilepsy

caution if elderly or renal impairment

Question 11

side effects of codeine

Answer 11

• constipation, nausea, drowsiness, dizziness
• decreases seizure threshold
• neuro and respiratory depression

Question 12

possible interactions of codeine

Answer 12

• sedative drugs

- drugs which decrease seizure threshold

Question 13

examples of strong opioids

Answer 13

morphine

Question 14

how does morphine work

Answer 14

acts as an agonist for opioid receptors in the CNS, decreasing neuronal excitability and sympathetic response - decreases pain transmission

Question 15

when is morphine used

Answer 15

• acute severe pain
• chronic pain
• palliative care
• to reduce breathlessness in acute pulmonary oedema

Question 16

contraindications of morphine

Answer 16

caution in elderly, hepatic and renal impairment

Question 17

side effects of morphine

Answer 17

neuro and resp system depression, constipation, pupillary restriction, itching, dependence and withdrawal

Question 18

possible interactions of morphine

Answer 18

sedative drugs

Question 19

examples of non-opioid pain relief

Answer 19

paracetamol

Question 20

how does paracetamol work

Answer 20

partially unknown

- inhibits inflammation by prostaglandins by inhibiting cyclooxyganse

Question 21

when is paracetamol used

Answer 21

first line analgesia

Question 22

when is paracetamol contraindicated

Answer 22

caution if hepatic impairment or toxicity

Question 23

side effects of paracetamol

Answer 23

n/a

overdose can cause liver toxicity

Question 24

possible interactions of paracetamol

Answer 24

CYP450 inducers may increase rate of liver failure in overdose

Question 25

example of xanthine oxidase inhibitor

Answer 25

allopurinol

Question 26

how does allopurinol work

Answer 26

xanthine oxidase inhibitor so inhibits xanthine oxidase which normal turns xanthine into uric acid - in turn, reducing uric acid concentrations

Question 27

when is allopurinol used

Answer 27

• gout prevention
• renal stone (uric acid) prevention
• prevention of hyperuricaemia

Question 28

contraindications of allopurinol

Answer 28

do not give if acute attack of gout, skin rashes, hypersensitivity
caution in renal and hepatic impairment

Question 29

side effects of allopurinol

Answer 29

not many

• skin rash
• may worsen or trigger gout if during an attack
• hypersensitivity may lead to SKS

Question 30

possible interactions of allopurinol

Answer 30

• ACEi increases risk of hypersensitivity reactions

- metabolises azathioprine