Pain, pain, go away Flashcards
Why should pethidine be avoided
accumulation of neurotoxic metabolic can percipitate seizures
Are opioids effective in dental pain
no, rarely
why are NSAIDs a good choice for bone pain
secondary bone tumouts can produce lysis of bone and release of prostaglandins
Co-proxamol is no longer licensed why
toxicity in overdose - although may still be used in patients who find it hard to change
Buprenorphine’s effects are not fully reverse by naloxone because
partical ag and antag properties
why is dipipanone not suitable for prescribing often?
only available in formulations with an antiemetic
alfentanil, remifentanyl and fentanyl are used for analgesia when?
intraoperatively
morphine should not be adminstered more than ……. daily to avoid accumulation
twice
(may be used for pain if patient needs oral solution but experience exacerbation of pain with oramorph
pentazocine is not often used because
hallucinations and may increase cardiac work
MOA of tramadol
opioid and seratanergic and adrenergic pathway enhancement
s/e of giving intrathecal opioids post op
urinary retention, nausea, vomiting, resp depression
three odd side-effects of opioids used long term
hypogonadism and adrenal insufficiency - amenorrhoea, reduced labido, erectile dysfunction
hyperalgesia - increas diffuse and less defined pain, needs specilst referal to then reduce opioids
symptom of opioid overdose
coma, pinpoint pupils, resp depression
if no strength is stated on co-codamol rx what should you supply
8/500
steps to treatment of migrane
normal analgestics 5HT Ag (triptans)
why are dispersible preparations preferred in migranes
peristatsis may be reduced in migranes
why are overusing 5HT ag for migranes a problem
may cause medication overuse headache
What NSAID is specifically licensed for le migranes
tolfenamic acid
why are ergot alkaloids such as ergotamine not really used
absorption dificuluties, nausea, vom, abdo pain and muscle cramp side-effects
what antiemetics are used for migranes
metoclopramide
domperidone
phenothiazine (e.g. promethazine) and antihistamines
four lifestyle factors that may prevent migrane
COC
lack of sleep
chemical triggers (alcohol, nitrates)
stress
prophylaxis of migrsines should be considered if (4)
increasing frequency
at least two attacks a month
treatment is inadequate
cannot take treatment
4 meds for prophylaxis of migrate
beta blockers
TCAs
pizotifen (weight gain)
Botox
what opioids is there evidence for in neuropathic pain
tramadol
for specialists:
morphine
oxycodone
what is taken during the acute stage of trigeminal neuralgia to reduce frequency and severity of attacks
why titrate up slowly?
cabemazepine - to avoid side-effects such as dizziness
sometimes phenytoin
NSAIDs associated with lowest risk ofGI and thrombotic events
Naproxen 1g daily
and
ibuprofen 1.2g daily
Selective Cox 2 inhibitors are associated with more or less GI sideeffects than NSAIDs
less
are NSAIDs used in chrons
cautioned - may exacerbate
what is the effect of NSAIDs on fertility
reversibly reduced
NSAID associated with a BNF box warning:
What are the rules?
piroxicam
not first line
RA, OA or AS only
max 20mg
(only applies to oral prep not topical prep)
NSAID associated with cystitis with BNF box warning
Tiaprofenic acid
- contraindicated with history of UTI
cousell to stop taking if symptoms develop
NSAID associated with headache, dizziness and upset stomach
indometacin
