Pain quiz Flashcards
Possible differentials for a 67 year old man diagnosed with inoperable SCC of the right lung 2 months ago
Treated with 2 fractions of palliative radiotherapy
Admitted yesterday with increasing breathlessness; drainage of his new pleural effusion is planned for tomorrow
Cancer
- Chest wall invasion, bone metastases, MSCC
Treatment
- Oesophagitis, local reaction to RT
Other
- CAP, PE, pneumothorax, MI, anxiety
What non-opioid should you prescribe if there is no cardiovascular risk or GI risk?
Ibuprofen or naproxen
(All with PPIs)
What non-opioid should you prescribe if there is no cardiovascular risk but a GI risk?
COX2 inhibitors like Celecoxib
What non-opioid should you prescribe if there is no cardiovascular risk or GI risk?
Naproxen or ibuprofen
5 classes of adjuvant pain relief
Antidepressants
- Amitriptyline
- Duloxetine
Anticonvulsants
- Gabapentin
- Pregabalin
Benzodiazepines
- Diazepam
- Clonazepam
Steroids
- Dexamethasone
Bisphosphonates
- Pamidronate
- Zoledronic acid
What are some side effects of Amitriptyline?
- Confusion
- Hypotension
What are some side effects of gabapentin?
- Sedation
- Tremor
- Confusion
- Dizziness
Is there a role for weak opioids (Codeine phosphate/Dihydrocodeine/Tramadol)?
Not really
Low dose morphine often provides quicker and better pain relief than a weak opioid
Examples of strong opioids
- Oxycodone
- Diamorphine
- Fentanyl
- Buprenorphine
What are the common initial side effects with opioids?
- N&V
- Drowsiness
- Light headedness/unsteadiness
- Cognitive impairment
What are the common on-going side effects of opioids?
Constipation
Dry mouth
What is the ratio in strength between codeine and morphine?
Codeine:morphine
10:1
What is the maximum dose of codeine you can have in a day?
240mg
Equates to 24mg of morphine in 24 hours
Name of immediate release morphine and amounts it comes in
Oramorph
10mg/5ml
Name of slow release morphine and amounts it comes in
Zomorph capsules BD
10, 30, 60, 100, 200
MST tablets
5, 10, 15mg
