Therapeutic Groups

Question 1

Nociceptive Pain

Answer 1

Response to a pathophysiologic process occurring within the tissues (e.g. inflammation). The pain signal originates from intact primary afferent nerves that signal noxious events, or nociceptors.

Question 2

Neuropathic Pain

Answer 2

Response to a pathologic process occurring along and within the nervous system pain pathways. The pain signal is generated ectopically and often in the absence of ongoing noxious events by pathologic processes in the PNS or CNS.

Question 3

Adjuvant Analgesics

Answer 3

Medicines that are intended for indications other than pain, but can also be used as analgesics in select circumstances.

Question 4

What are the possible routes of administration of Paracetamol?

Answer 4

Oral
Rectal
IV

Question 5

Which NSAIDs tend to produce more GI toxicity?

Answer 5

COX-1 selective inhibitors

Question 6

What are the contraindications of diclofenac?

Answer 6

IHD, PAD, cerebrovascular disease and congestive heart failure

Question 7

What are the contraindications of high dose ibruprofen?

Answer 7

Should be avoided in IHD, PAD, cerebrovascular disease, congestive heart failure and uncontrolled hypertension

Question 8

Examples of COX-2 selective NSAIDs?

Answer 8

Celecoxib
Etoricoxib

Question 9

Recommended aspirin dose for analgesia in adults

Answer 9

300-900 mg every 4 to 6 hours
Maximum of 4g in 24 hours

Question 10

Aspirin dosage for children

Answer 10

Do not prescribe aspirin to patients under the age of 16 for the management of pain.
Associated with Reye’s syndrome

Question 11

Common adverse effects of weak opiods

Answer 11

Constipation
Mental clouding
Somnolence

Question 12

Less common adverse effects of weak opiods

Answer 12

Amenorrhoea
Headache
Itch
Myoclonus
Nausea
Sexual dysfunction
Sweating
Urinary retention

Question 13

Weak opiods

Answer 13

Codeine
Dihydrocodeine
Tramadol

Question 14

What routes of administration are available for codeine?

Answer 14

Orally or IM
Should not be administered IV due to risk of anaphylactic reaction

Question 15

Co-dydramol

Answer 15

Dihydrocodeine (10, 20 or 30 mg) combined with paracetamol (500mg)

Question 16

Co-codamol

Answer 16

Codeine (8, 15 or 30mg) combined with paracetamol (500mg)

Question 17

Tramacet (C)

Answer 17

Tramadol (37.5mg) combined with paracetamol (325mg)

Question 18

First-line strong opiod

Answer 18

Morphine sulfate

Question 19

Examples of strong opiods

Answer 19

Buprenorphine
Diamorphine
Fentanyl
Hydromorphone
Oxycodone
Methadone (under specialist supervision only)

Question 20

Antidepressants for adjuvant analgesia

Answer 20

Tricyclic antidepressants (e.g. amitriptyline licensed for neuropathic pain)
SNRIs (e.g. duloxetine licensed for diabetic neuropathy)

Question 21

Antiseizure medications for adjuvant analgesia

Answer 21

• Carbamazepine (licensed for treatment of trigeminal neuralgia and ‘off-label’ use for diabetic neuropathy
• Gabapentin (licensed for neuropathic pain)
• Lamotrigine
• Pregabalin (licensed for neuropathic pain)

Question 22

NMDA-receptor antagonists for adjuvant analgesia

Answer 22

Amantadine
Ketamine
Magnesium
Methadone

Question 23

Recommendations for management of neuropathic pain

Answer 23

Antidepressant or antiseizure medication either alone or in combination with non-pharmacological management such as surgical treatment and psychological interventions

Question 24

First line treatment for trigeminal neuralgia

Answer 24

Antiseizure medication - carbamazepine recommended by NICE

Question 25

Signs of mild LA toxicity

Answer 25

Tingling around mouth/extremities
Metallic taste
Visual disturbances

Question 26

Signs of moderate LA toxicity

Answer 26

Altered level of consciousness
Convulsions

Question 27

Signs of potentially fatal LA toxicity

Answer 27

Dysrhythmias
Cardiovascular collapse
Respiratory arrest