Pain Management

Question 1

what are the side effects of opioids?

Answer 1

• somnolence
• respiratory depression
• hypotension
• constipation
• confusion
• dry mouth
• urinary retension
• N&V due to direct stimulation of CTZ

Question 2

what is the antidote for opioid overdose?

Answer 2

naloxone

Question 3

Naloxone is a competitive antagonist of opioids. what is a competitive antagonist?

Answer 3

drugs that bind to the receptor in a reversible way without activating the effector system for that receptor

Question 4

what is meant by multimodal analgesia?

Answer 4

using several agents that act at different sights in the pain pathway to manage pain

Question 5

what are step 1 drugs on teh WHO analgesic ladder?

Answer 5

paracetamol

NSAIDs

Question 6

what are step 2 drugs on the WHO analgesic ladder?

Answer 6

add in weak opioids (codeine or dihydrocodeine).

co-codamol is a ready-made mixture of codeine + paracetamol

Question 7

what risk do you need to consider when adding in opioids in pain management?

Answer 7

dependence

Question 8

what is a step 3 drug on the pain ladder?

Answer 8

morphine

Question 9

how long does pain typically have to last for to be classified as being chronic?

Answer 9

3 months

Question 10

what is first line treatment for someone with neuropathic pain?

Answer 10

anticonvulsant e.g. gabapentin or pregabalin

Question 11

what is an alternative first-line approach to someone with neuropathic pain if anticonvulsants don’t work or patient doesn’t want to use them?

Answer 11

tricyclic antidepressents

Question 12

how long does morphine solution have an analgesic effect for?

Answer 12

4 hrs

so oramorph can be given 6 times in 24hrs