PAIN - pain relief

Question 1

name the different types of analgesics?

Answer 1

non opioid - paracetamol
NSAIDS - ibuprofen, naproxen, diclofenac, aspirin
Mild opioids - codeine and dihydrocodeine (sold OTC with something e.g cocodamol, solpadeine)

Question 2

effects of paracetamol

Answer 2

reduces pain and fever - anti-pyretic, analgesic

Question 3

what are the maximum OTC pack size of paracetamol

Answer 3

maximum 100 tablets - But as they come in pack sizes of 32 then the maximum is 96 tabs.

Question 4

what is the adult dose of paracetamol

Answer 4

500-1000mg 4x a day - maximum of 1g in 24hours. (8tabs)

Question 5

effects of ibuprofen?

Answer 5

anti inflammatory, anti-pyretic and analgesic

Question 6

adult dose of ibuprofen

Answer 6

200-400mg TDS with FOOD

Question 7

what are the cautions of ibuprofen?

Answer 7

• thins lining of the stomach- causes acid reflux so not good in stomach ulcers
• causes blood pooling and increases the tightness of chest so increases chances of an asthma attack
• increases blood pressure
• GI disturbance

Question 8

effects of aspirin

Answer 8

analgesic
anti-pyretic
anti-inflammatory

Question 9

adult dose of aspirin

Answer 9

300-900mg every 4-6 hours - maximum of 4g in 24hours with FOOD
Not for children under 16 years

Question 10

Max OTC supply of aspirin

Answer 10

100 tablets but pack sizes of 32 so 96

Question 11

side effects of aspirin

Answer 11

GI irritation, dyspepsia, hypersensitivity

Question 12

What are opioids?

Answer 12

strongest OTC painkillers e.g codeine

Question 13

What are the legal restrictions of the sale of opioids?

the restrictions imposed on the sale of opioids for pain relief

Answer 13

• Max OTC supply is 32 (solid and effervescent) 1 box of 32 and can’t buy any other painkillers
• Indication is for short term treatment of acute moderate pain that is not relieved by paracetamol, ibuprofen, aspirin alone
• on the label - can cause addiction, for maximum 3 days only

Question 14

What are the side effects of opioids?

Answer 14

constipation, drowsiness

Question 15

what is the dose of opioids?

Answer 15

Codeine 8-10 mg per tablet - with paracetamol or ibuprofen. Not suitable in below 12 years, 3 day use

Question 16

why is caffeine included in analgesics and what are the side effects?

Answer 16

It is a stimulant - It lowers the gastric pH and helps absorption of the analgesic so it has a faster onset or action and works better.

• Side effects are that it can increase heart rate and blood pressure. Also keeps you awake
• It is prone to abuse- people don’t realise it is real caffeine, they think it keeps them going and the pain goes away so keep taking and postpone going to see the Dr - dependant and misuse

Question 17

What is the usual dose of caffeine in analgesics?

Answer 17

130mg - same as a cup of coffee or tea

Question 18

what patient groups need intervention if they want to buy painkillers?

Answer 18

• service users e.g heroin addicts, alcoholics
• pregnant/breastfeeding
• elderly
• children
• asthmatics, diabetics, cancer, cardiac, renal
• immunocompromised

Question 19

what analgesic is dafe to use in pregnancy?

Answer 19

paracetamol

Question 20

Give 2 different types of over the counter analgesic and state the usual adult dose, giving examples

Answer 20

• Non opioid e.g paracetamol - 500-1000mg QDS adult dose - max 1g a day
• NSAIDS (non steroidal anti inflammatory) - e.g ibuprofen- 200-400mg TDS - with food

Question 21

Name an OTC analgesic that can cause constipation

Answer 21

opioids e.g codeine (co codamol)

Question 22

Name an OTC analgesic that has risks for asthma patients and explain

Answer 22

Ibuprofen - increases the risk of an asthma attack as it increases blood pooling and chest tightness

Question 23

age restrictions for:
aspirin
opioids e.g codeine

Answer 23

aspirin -must be >16

opioids- must be >12

Question 24

what analgesics must be taken with or after food?

Answer 24

Ibuprofen (due to thins lining of the stomach)

Aspirin (NSAID too)

Question 25

Treatments for general & tension headaches

Answer 25

(a) remove or treat the cause e.g dehydration etc.
1. oral analgesics - NSAIDS if no contra indications, paracetamol or combination

2. alternatives suchas cooling/menthol

Question 26

treatments for migraines

Answer 26

1. simple analgesia as per general (liquid can act faster)

2. Specific OTC for migraines

Question 27

Describe the specific OTC medication for migraines

Answer 27

1. migraleve -
   pink = paracetamol, codeine, buclizine (anti emetic - sickness)
   Yellow - paracetamol and codeine (use once the nauseousness has gone)
2. Sumitriptan (imigran)
   license for patients with a stable history of migraines - only if they meet the requirements
3. buccastem M - contains prochlorperazine - buccal anti-emetic - only licensed for use in migraines

Question 28

Describe the legal restrictions on the sale of OTC paracetamol and aspirin

Answer 28

BOTH:
not more than 100 non-effervescent tablets/capsules to be sold to a person at any one time
- Most pack sizes are 16 or 32 dose units - in practice, less than 100 can be sold

BUT - no legal limits on the quantity of effervescent tablets, powders, liquids or granules -must use professional judgement on this.