Pain Management

Question 1

What are the two major types of pain?

Answer 1

Nociceptive
Neuropathic

Question 2

What is nociceptive pain?

Answer 2

NORMAL
Free nerve endings activated

Question 3

What is neuropathic pain?

Answer 3

ABNORMAL processing of stimuli from PNS or CNS that serves no useful purpose

Question 4

How does paracetamol treat pain

Answer 4

Inhibits prostaglandin synthesis centrally

Question 5

Which two organs should be monitored when giving paracetamol?

Answer 5

Kidneys and liver

Question 6

How do NSAIDs work

Answer 6

Inhibit synthesis of prostaglandins (good anti-inflammatory agents). This is achieved by inhibiting the COX-1/2 pathways

Question 7

when do you NOT use NSAIDS

Answer 7

ACTIVE peptic ulceration, hypersensitivity to NSAIDs

Question 8

what are some of the benefits of using COX-2 inhibitors

Answer 8

Less GIT toxicity than non-selective NSAIDs

Question 9

what are some of the disadvantages associated with COX-2 NSAIDs as if you inhibit COX-1, you inhibit platelet aggreg.

Answer 9

Increased CVS risk (MI and Stroke)

Question 10

What are some of the adverse effects of NSAIDs

Answer 10

Bronchoconstriction
Bleeding
Dyspepsia and Peptic Ulceration
Fluid retention
Hypersensitivity
Hepatotoxicity
Nephropathy and ARF

Question 11

Are COX-2 inhibitors suitable for patients with IHD or CVD?

Answer 11

No

Question 12

What are some of the CNS effects of morphine?

Answer 12

Euphoria, sedation, analgesia

Question 13

how do opioids work?

Answer 13

Histamine is released resulting in vasodilation, itching and bronchoconstriction

Question 14

how do you administer morphine

Answer 14

10mg 4 hourly for 24 hours, increase by 30-50%

Question 15

what are some of the adverse side effects of morphine

Answer 15

nausea, sedation, constipation, resp depression

Question 16

which population groups should take morphine with caution

Answer 16

Renal & Hep impairment, Preggers, Neonates, lactation, elderly, COPD & acute asthma (decr. pulmonary reserve)

Question 17

What type of opioid is tramadol?

Answer 17

Moderate to severe pain
u receptor agonist
Prevents reuptake of serotonin and noradrenaline
Can get Serotonin Syndrome (when combined to SSRI, MAOIs)
Metabolism induced by carbamazepine
Less severe side effects

Question 18

What is one disadvantage of tramadol

Answer 18

it lowers seizure threshold

Question 19

What is a huge pro of tramadol

Answer 19

Synergistic analgesic with paracetamol

Question 20

codeine phosphate properties

Answer 20

Mild to moderate pain
Weak opioid
Adverse effects as with morphine

Question 21

Codeine Phosphate CYP2D6 variant

Answer 21

Slow metaboliser: poor analgesic effect but constipation
Rapid metaboliser: Resp depression, coma and death

Question 22

What is chronic pain?

Answer 22

4-6 week duration

Question 23

Somatic chronic pain

Answer 23

Arthritis, fibromyalgia, lower back pain

Question 24

Visceral chronic pain

Answer 24

pleurisy, cancer pain

Question 25

Neuropathic pain

Answer 25

Diabetic neuropathy
Trigeminal neuralgia
Post-herpetic neuralgia
Peripheral neuropathy

Question 26

examples of adjuvant therapy

Answer 26

TCA: amitriptyline
analgesic
anxiolytic
antidepressant
sedative
start at 10-25mg nocte (good if pain associated with sleep and anxiety disorder)

Anticonvulsants:
Carbamazepine, valproate, gabapentin
Good for neuropathic pain
can be used with TCA