PAIN - pain relief Flashcards
name the different types of analgesics?
non opioid - paracetamol
NSAIDS - ibuprofen, naproxen, diclofenac, aspirin
Mild opioids - codeine and dihydrocodeine (sold OTC with something e.g cocodamol, solpadeine)
effects of paracetamol
reduces pain and fever - anti-pyretic, analgesic
what are the maximum OTC pack size of paracetamol
maximum 100 tablets - But as they come in pack sizes of 32 then the maximum is 96 tabs.
what is the adult dose of paracetamol
500-1000mg 4x a day - maximum of 1g in 24hours. (8tabs)
effects of ibuprofen?
anti inflammatory, anti-pyretic and analgesic
adult dose of ibuprofen
200-400mg TDS with FOOD
what are the cautions of ibuprofen?
- 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
effects of aspirin
analgesic
anti-pyretic
anti-inflammatory
adult dose of aspirin
300-900mg every 4-6 hours - maximum of 4g in 24hours with FOOD
Not for children under 16 years
Max OTC supply of aspirin
100 tablets but pack sizes of 32 so 96
side effects of aspirin
GI irritation, dyspepsia, hypersensitivity
What are opioids?
strongest OTC painkillers e.g codeine
What are the legal restrictions of the sale of opioids?
the restrictions imposed on the sale of opioids for pain relief
- 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
What are the side effects of opioids?
constipation, drowsiness
what is the dose of opioids?
Codeine 8-10 mg per tablet - with paracetamol or ibuprofen. Not suitable in below 12 years, 3 day use
why is caffeine included in analgesics and what are the side effects?
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
What is the usual dose of caffeine in analgesics?
130mg - same as a cup of coffee or tea
what patient groups need intervention if they want to buy painkillers?
- service users e.g heroin addicts, alcoholics
- pregnant/breastfeeding
- elderly
- children
- asthmatics, diabetics, cancer, cardiac, renal
- immunocompromised
what analgesic is dafe to use in pregnancy?
paracetamol
Give 2 different types of over the counter analgesic and state the usual adult dose, giving examples
- 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
Name an OTC analgesic that can cause constipation
opioids e.g codeine (co codamol)
Name an OTC analgesic that has risks for asthma patients and explain
Ibuprofen - increases the risk of an asthma attack as it increases blood pooling and chest tightness
age restrictions for:
aspirin
opioids e.g codeine
aspirin -must be >16
opioids- must be >12
what analgesics must be taken with or after food?
Ibuprofen (due to thins lining of the stomach)
Aspirin (NSAID too)
Treatments for general & tension headaches
(a) remove or treat the cause e.g dehydration etc.
1. oral analgesics - NSAIDS if no contra indications, paracetamol or combination
- alternatives suchas cooling/menthol
treatments for migraines
- simple analgesia as per general (liquid can act faster)
2. Specific OTC for migraines
Describe the specific OTC medication for migraines
- migraleve -
pink = paracetamol, codeine, buclizine (anti emetic - sickness)
Yellow - paracetamol and codeine (use once the nauseousness has gone) - Sumitriptan (imigran)
license for patients with a stable history of migraines - only if they meet the requirements - buccastem M - contains prochlorperazine - buccal anti-emetic - only licensed for use in migraines
Describe the legal restrictions on the sale of OTC paracetamol and aspirin
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.
