Symptoms In The Pharmacy - Pain Conditions Flashcards
What is pain?
The International Association for the Study of Pain (IASP) definition for pain: an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage
What is acute pain + causes?
Sudden onset - sharp or intense
Serves as a warning sign of disease or threat to the body.
Caused by injury, surgery, illness, trauma, or painful medical procedures
Lasts from a few minutes to less than 3 months
Usually disappears whenever the
underlying cause is treated or healed
What is an analgesic?
An analgesic is a medication used
to reduce pain
What is an anti-pyretic?
Anti-pyretic – reduces body temperature (fever)
What is paracetamol? + what does it do in terms of dosage types + why we give it
Paracetamol inhibits the cyclooxygenase
(COX) enzyme
Child – suspension – easier to swallow, &
taste
Soluble tablets – easier to swallow &Soluble tablets – easier to swallow &
absorbed more quicklyabsorbed more quickly
Safe in pregnancy and breastfeeding
Dose based on narrow age bands – not
practical for consumers to calculate dose
based on body-weight (mg/kg)
What are the uses of paracetamol?
- For mild to moderate pain e.g.
*HeadacheHeadache - MigraineMigraine
- Toothache (refer if abscess)Toothache (refer if abscess)
- DysmenorrhoeaDysmenorrhoea
- FeverFever
- OsteoarthritisOsteoarthritis
*Less GI irritation compared with NSAIDs
What are the cautions for paracetamol?
- BNF – please read appropriate sections for
cautions and CI and interactions - Risk factors for hepatotoxicity-
- liver or kidney dysfunctionliver or kidney dysfunction
Malnutrition, dehydration, alcohol misuseMalnutrition, dehydration, alcohol misuse - Older, frail patientOlder, frail patient
- Body weight<50kg, enzyme inducing medicationBody weight<50kg, enzyme inducing medication
- Overdose – nausea and vomiting then liver
failure (after 4-6 days)
What is paracetamol suspension used for?
for mild to moderate pain & as an antipyretic
Suitable for children
* from 2 months(=>4kg)
for post-immunisation
pyrexia
* from 3 months for fever
and pain
What is NSAIDs mechanism of action?
- Non-selective NSAIDs e.g.
- Ibuprofen, Aspirin,Ibuprofen, Aspirin, Naproxen, DiclofenacNaproxen, Diclofenac
(topical)(topical) - Inhibit prostaglandin (PG) synthesis by
reversibly inhibiting cyclo-oxygenase
(COX) enzymes — COX-1 and COX-2 - COX-1 produces PG that help to maintainCOX-1 produces PG that help to maintain
gastric mucosal integrity and platelet-initiatedgastric mucosal integrity and platelet-initiated
blood clottingblood clotting - COX-2 produces PG that mediate pain andCOX-2 produces PG that mediate pain and
inflammationinflammatio
What is the caution around NSAIDs?
Asthma (can induce asthma attack in 10%)Asthma (can induce asthma attack in 10%)
** Class effectClass effect
* Kidney impairment (decreases renal function)Kidney impairment (decreases renal function)
* Cardiovascular disease & HypertensionCardiovascular disease & Hypertension
* Inflammatory bowel disease such as Crohn’sInflammatory bowel disease such as Crohn’s
disease or Ulcerative colitisdisease or Ulcerative coliti
What are the contraindictions of NSAIDs?
- Active peptic ulceration or GI bleedingActive peptic ulceration or GI bleeding
- Severe heart, renal or liver failureSevere heart, renal or liver failure
- Pregnancy – Non-selective NSAIDsPregnancy – Non-selective NSAIDs
Contraindicated after 30 weeks of pregnancyContraindicated after 30 weeks of pregnancy
(Do not sell in pregnancy)(Do not sell in pregnancy) - Breastfeeding – Aspirin contraindicatedBreastfeeding – Aspirin contraindicated
NSAIDs interactions with other medicines, what are these medicines?
- Anticoagulant / antiplatelet
- Other NSAIDs
- Ciclosporin
- Diuretics
- ACE inhibitors
- Lithium
- Methotrexate
- SSRIs
What are the uses for NSAIDs for mild to moderate pain?
*sprains
*strains
*headache
*toothache
*colds and flu
*Dysmenorrhoea
What are the indications for taking ibuprofen?
- Adult oral dose = 200mg -Adult oral dose = 200mg -
400mg up to 3 times a400mg up to 3 times a
day (no more frequentlyday (no more frequently
than every four hours).than every four hours). - Max dose = 1200mg in 24Max dose = 1200mg in 24
hours.hours. - Take with or after foodTake with or after food
- Nurofen caplets – not forNurofen caplets – not for
use in under 12yearsuse in under 12year
What are the indications and conditions of taking naproxen?
- Licensed for period painLicensed for period pain
and menstrual cramps forand menstrual cramps for
≥15 – 55 years of age≥15 – 55 years of age - MaxMax three 250mg tabletsthree 250mg tablets
per dayper day - Take with or just after aTake with or just after a
meal or snackmeal or snack - Not to be taken for moreNot to be taken for more than three days in any one cycleone cycle.
What are the indications for ibuprofen 100mg/5ml?
- Fever, symptomatic relief of colds and influenza, mile to moderate pain – sore throat,influenza, mile to moderate pain – sore throat,
teething, toothache, headache, minor aches and sprains
What are the licensed doses for ibuprofen 100mg/5ml?
3 to 6 months & >5kg: 2.5ml three times a day for 24 hours only
* (Avoid in chickenpox)
What is aspirin for? + contraindication
- For mild to moderate pain in adults and children over 16
- Contraindicated in <16 years – can cause Reye’s syndrome (resulting in serious liver and brain damage)
What are the typical aspirin doses?
- Usual adult oral dose = 300mg – 600mg every 4 to 6 hours. Max dose = 3600mg / 24 hours
- Disclaimer = Aspirin 75mg for cardiovascular risk - not for pain - prolonged effect as an anti-platelet
What is co-codamol? what for?
Pro-drug - Metabolised by
liver enzymes (CYP2D6)liver enzymes (CYP2D6) into morphine
Acute moderate pain (not anti-pyretic & not anti- inflammatory)
Combined with paracetamol OTC, etc (co- codamol 8mg/500mg
licensed from 12yo)licensed from 12yo
Dihydrocoedine, what is it and what for?
Acts directly on Mu opioid
receptors
Acute moderate pain (not anti-pyretic & not anti- inflammatory)
Combined with paracetamol OTC eg
(Paracetamol 500mg & dihydrocodeine 7.46mg)
licensed from 12yo
What are some issues with codeine and dihydrocodeine? (contraindications + side effects)
Common side effects = constipation,
nausea, drowsiness
Although can be used in Pregnancy – do not sell OTC = refer to GP
Contraindicated in breastfeeding
Risk of addiction/ dependence
* Max 3 days
* Can make headaches worse
* If used for > 3 days
What is caffeine?
a weak stimulant that is thought
to enhance the analgesic effect & increase absorption(?)
What is antihistamine?
can act as muscle
relaxants and can help with sleep e.g.
Diphenhydramine, doxylamine
What is a sprain?
a torn, stretched or twisted
ligament. Symptoms = bruising,
swelling, inability to move the joint.
e.g., sprained ankle or knee
What is a strain?
the stretch or tearing of
muscles or tendons. Symptoms =
tenderness and swelling
When to refer someone with a sprain/strain/pain?
Fracture or dislocation – inability to
weight bear
Severe pain on movement
Persistent pain, even when at rest
Numbness - neuralgia symptoms
Symptoms that have not improved
after 48 hours
What is osteoarthritis? + extra
Affects knees, hips
& small joints of the
hand
Loss of cartilage with joint remodelling
Activity related pain
Typically aged >45years
No early morning stiffness (or
stiffness lasting no longer than 30
minutes)
Functional impairment-
movement limited
What is the pharmacological management of osteoarthritis?
- Paracetamol or topical NSAID = first line
- Consider oral NSAID if simple analgesia ineffective
(topical NSAID should then be discontinued) - Consider weak opioid e.g. codeine when required if
NSAID not tolerated or not effective
What is the non pharmacological management of osteoarthritis?
weight management and exercise, physio
What is back pain + commonness?
*Most lower back pain is non-specific
*Most often seen in those aged 35 to 55 years
*Up to 60% of adults have lower back pain at some point in their lives
*Common cause of absence from work
What are the risk factors of back pain?
*age
* genetics
*fitness
*weight
*mental health
*job related activities
*smoking
What are the red flags of back pain?
- Major trauma
- Minor trauma in elderly, or
osteoporotic - Age <20 or >50 years old
- History of malignancy
- Constitutional symptoms
(fever, chills, weight loss) - Recent bacterial infection
- Intravenous drug use
- Immunosuppression
- Pain worsening at night, or
when supine - Severe or progressive
sensory alteration, or
weakness - Bladder, or bowel dysfunction
What is the pharmacological management of back pain?
1st line - Oral NSAIDs e.g. Ibuprofen or Naproxen (consider risks and use lowest doses for shorted time)
THEN AFTER
Codeine + Paracetamol
Only consider if NSAID
contraindicated, not tolerated or
ineffective (for acute back pain only)
What is sciatica?
*Irritation or compression of sciatic nerve (largest
nerve in body), runs from back of the pelvis through the buttocks down rear of both legs and divides into 2 nerves above the knee.
* Usually due to inflammatory condition that irritates the sciatic nerve
What are the symptoms of sciatica?
Symptoms = tingling sensation, may be described as shooting or stabbing
* 5-10% of people with non-specific lower back pain also have sciatica pain
What is a tension headache and what it entails?
- Most common
*All age groups and sexes equally - Bilateral - dull ache
- Tight band feeling
worsen as day progresses - Mild to moderate, not
disabling - No other associated symptoms
- 30 minutes – 7 days
What is a migraine and what it entails?
*Less common
* More common in females
* Generally unilateral (bilateral in children)
* Pulsating/throbbing
* Moderate/ severe
* Nausea/ vomiting/ photophobia
* Prevents routine activities
* Last hours – 72 hours
When to refer a patient with a headache?
Sudden, severe, frequent
or cluster headaches,
thunderclap headaches
Migraine headaches for
the first time
Headaches in children
People experiencing
headaches
* following a head injury
* with slurred speech
* With confusion
* With a rash, stiff neck or
vomiting
Overuse of medications headaches, why is this an issue?
Headache on 15 or > days/ month in a person with a pre-existing headache disorder and
* Regular overuse for > 3 months
* For ergotamine, triptans, opioids and combination analgesics intake must be 10 days or more per
month
What is a sinus headache?
Caused by build up of pressure
in the sinuses e.g. during or after a cold
What are the symptoms of a sinus headache?
*Throbbing pain – worse
during head movement
* Toothache
* Pain in jaw on eating
* Pain that is worse in the
morning
* Increased mucus
* More pain when bending
forward
What is a migraine with aura, what does it entail?
Aura – warning signal
before migraine begins
* Visual disturbances e.g. zig
zag patterns, flashing
lights, blind spots
* Tingling sensations or
stiffness in neck, shoulders,
limbs
*Co-ordination issues or
problems with speaking
What is a migraine without aura, what does it entail?
*no aura
*nausea and vomiting
*photophobia, phonophobia
What are some possible migraine triggers?
*changes in routine
*hormonal changes
*emotional changes
*medicines
*dietary factors
*physical factors
*environmental factors
What are the five stages of a migraine?
1: prodromal (premonitory) - up to 24hrs
2: aura (5min to 60mins)
3:headache
4:resolution
5:recovery or post-dromal phase (hours to days)
What are the treatment options for a migraine?
*ibuprofen, aspirin and paracetamol
*Gut motility can slow down
during a migraine attack –
products may take longer to
absorb
What medicine is not recommended for a migraine and why?
Co-codamol = not recommended as codeine can make nausea and vomiting worse
What medicine is recommended for a migraine and why?
Migraleve pink = licensed for migraine - contains paracetamol and codeine with buclizine (an antihistamine that helps to
prevent nauseous feeling)
What is sumatriptan?
“Triptan” - 5HT1 agonist - not an analgesic
Licensed (18 – 65yo) where clear diagnosis of migraine
One tablet ASAP after migraine onset
Dose can be repeated after symptoms recur after min 2 hours
Acts on vascular 5-HT1D receptor found predominantly in cranial blood vessels leading to vasoconstriction
What are the contraindications of sumatriptan?
Allergy to sumatriptan
Myocardial infarction
Ischaemic heart disease
Coronary vasospasm
(Prinzmetal’s
angina)
Peripheral vascular disease
Hypertension
Stroke Liver Impairment
