Pain Mangement Neuro

Question 1

Somatic p💊

Answer 1

injury to tissues, well localized

Most analgesics will help, if severe, needs a potent analgesia

Question 2

Visceral p💊

Answer 2

injury to organs (stretch receptors), poorly localized

Potent pain analgesia

Question 3

Bone o 💊

Answer 3

Potent pain meds, opiates with NSAIDS as adjunct

Question 4

Neuropathic pain 💊

Answer 4

The nervous system itself damaged, to plexuses, spinal cord. May not respond as well to usual analgesics including opioids

eg trigeminal neuralgia, DM neuropathy

Opiates + tricyclic antidepressants or other adjuvant

Question 5

Mixed pain (nociceptive + neuropathic)

Answer 5

a- Hyperalgesia (an increased amount of pain associated with a mild noxious stimulus)

b- Allodynia (pain evoked by a non-noxious stimulus)

c- Breakthrough pain

Is it new incident (new cause? or end-of-dose?). Use 10% of total daily dose (rounded up) up to q 1-2 h

Question 6

1.Weak COX2 selective

Answer 6

diclofenac

piroxicam)
♥️Main therapeutic effects achieved via COX-2 inhibition
⬆️ CVS risk

Question 7

2.Moderate COX2 selective

Answer 7

celecoxib

⬆️ CVS risk

Question 8

3.Weak COX1 selective

Answer 8

aspirin, ibuprofen, naproxen

👾👾Cox 1 found in the stomach, kidney ,platelets ➡️nephrotoxic,ulcer ,anti platelets

Question 9

4.Highly COX1 selective

Answer 9

ketorolac
Nephrotoxic
👾👾Cox 1 found in the stomach, kidney ,platelets ➡️nephrotoxic,ulcer ,anti platelets

Question 10

Partial agonists opoids

Answer 10

Morphine is a partial agonist at μR similar to pethidine.

Codeine and tramadol are weak agonists

Question 11

1. Pure agonists. uR

Answer 11

Peptides eg endorphin: Non-peptides such as Fentanyl, and methadone.

Question 12

Antagonists of opoids

Answer 12

Naloxone and naltrexone

Question 13

Neuropathic pain relieving drugs 💊

Answer 13

Opoids+
Anticonvulsant 
gabapentin, carbamazepine
Anti-depressent
Ssri
Tca

Question 14

1.Paracetamol👾👾

Answer 14

had only mild analgesic and antipyretic effect

1- inhibits COX3 varient of COX1

2- Inhibits low rate of COX2

Question 15

Opoids use

Answer 15

:

1- Severe pain eg postoperative, cancer

2- Acute heart failure

3- Antidiarrheal

4- Antitussive

5- Refractory migraine

6- treatment of addiction

Question 16

Instructions and monitoring of effect/toxicity outcomes by NSAIDs

Answer 16

1- Taken on full stomach

3- Regular check of BP

4- Skin rash monitoring especially mefenamic, (urticuria, SJS)

5- Blood film monitoring monthly

6- Bronchospasm and bleeding time except COX2 inhibitors

7- Renal function test if prolonged time (eg paracetamol)

2- Epigastric pain monitoring,tarry stool

Causation of NSAIDs gastric ulcer in sequence

Ketoprofen > piroxicam > naproxen > diclofenac > aspirin > fenoprofen

Question 17

Neuronal Membrane stabilizers

Answer 17

• Ketamine, a dissociative anaesthesia
• Memantine blocks NMDA receptors in dorsal horn
• Ziconotide, blocks N-type Ca ch analgesic agents.

Question 18

Local anesthesia

Answer 18

1- Wound infiltration: 2 % lidocaine ( +/- adrenaline)

2- Nerve blocking: specific nerve distribution eg femoral nerve block

Advantages:

1- Excellent analgesia. 2- No sedation.

Complications

1- Bleeding, 2-Horners syndrome, 3- infection, 4-nerve injury,

5- spreeding of local anesthetic drug, 6- vascular injury, 7pneumothorax(according to the site of process