Pain Relief

Question 1

Indications of Ibuprofen?

Answer 1

Mild to moderate pain.
Pyrexia with discomfort.
Soft tissue injuries.

Question 2

Actions of Ibuprofen?

Answer 2

Analgesic (relieves pain).
Anti-pyretic (reduces temperature).
Anti-inflammatory (reduces inflammation).

Question 3

Contra-indications for Ibuprofen?

Answer 3

Dehydration.
Hypovolaemic.
Known renal insufficiency.
Active upper GI disturbance.
Last trimester of pregnancy.
Child with chickenpox.
Previous hypersensitivity reactions.
Active peptic ulcer/haemorrhage.
Severe heart failure, renal failure or hepatic failure.
Patient on anticoagulant drugs.

Question 4

Cautions of Ibuprofen?

Answer 4

Asthma - possible risk of hypersensitivity and bronchoconstriction. If asthmatic has not used before do not use.
Older people - >65 and have not used/tolerated NSAIDs recently.
Coagulation defects.
Crohn’s and ulcerative colitis may be exacerbated.
Ischaemic heart diseaes, peripheral arterial disease, cerebrovascular disease, congestive heart failure.
Hypertension.

Question 5

Side effects of Ibuprofen?

Answer 5

Nausea.
Vomiting.
Tinnitus.

Question 6

Dose of Ibuprofen?

Answer 6

400 mg, every 8 hours.
Max dose 1.2 g / 24 hours.

Question 7

Indications of Morphine?

Answer 7

Pain associated with suspected MI.
Severe pain as a component of a balanced analgesia regimen.
Oral morphine with moderate pain.

Question 8

Actions of Morphine?

Answer 8

Strong opioid analgesic.
Produces sedation, euphoria and analgesia.
May depress both respiration and induce hypotension, through vasodilation.

Question 9

Contra-indications for Morphine?

Answer 9

<1 year of age.
Respiratory depression.
Hypotension (<90 in adults, <80 in school children, <70 in pre-school children).
Head injury with impaired LOC (below P, or below 9).
Known hypersensitivity.

Question 10

Cautions for Morphine?

Answer 10

Severe renal or hepatic impairment - smaller doses titrated.
Patients with chest injuries, particularly respiratory difficulty unless pain inhibits respiration.
Head injury - may depress respiration.
Alcohol intoxication - opioids depress the nervous system as does alcohol.
Prescribed antidepressants, sedatives or tranquilizers may increase the respiratory and cardiovascular depressant effects of morphine.

Question 11

Side effects of Morphine?

Answer 11

Respiratory depression.
Cardiovascular depression.
Nausea and vomiting.
Drowsiness.
Pupil constriction.

Question 12

Dose of Morphine?

Answer 12

10 mg, repeated after 5 minutes, to a max of 20 mg.
2 mg per minute, to titrate effect.
If after 10 mg no reduction in pain, further 2 mg every 5 minutes.

Question 13

Indications of Paracetamol?

Answer 13

Relief of mild to moderate pain, or high temperature with discomfort.

Question 14

Actions of Paracetamol?

Answer 14

Analgesic and anti-pyretic.

Question 15

Contra-indications of Paracetamol?

Answer 15

Allergy.
Paracetamol-containing product given within 4 hours.

Question 16

Dose of Paracetamol?

Answer 16

500 mg - 1 g, every 4-6 hours.
Max dose 2-4 grams in 24 hours.

Question 17

Indications of Entonox?

Answer 17

Moderate-severe pain.
Labour pains.

Question 18

Contra-indications of Entonox?

Answer 18

Chest injury and suspected pneumothorax.
Severe head injuries with impaired consciousness - possible intracranial air.
Decompression sickness.
Violently disturbed psychiatric patients.
Intraocular injection of gas within last 8 weeks.
Abdominal pain with suspected intestinal obstruction.