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
