ACUTE PAIN MANAGEMENT AND GROWTH FALTERING Flashcards
what are the 3 steps to the analgesic pain ladder?
Step 1: Non-opioid medications such as paracetamol and NSAIDs
Step 2: Weak opioids such as codeine and tramadol
Step 3: Strong opioids such as morphine, oxycodone, fentanyl and buprenorphine
each step can be plus or minus adjuvant medications.
Other medications may be combined with the analgesic ladder for additional effect (called adjuvants) or used separately to manage neuropathic pain. These are:
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- Amitriptyline – a tricyclic antidepressant e.g. migraines, neuropathic pain, major depressive disorder
- Duloxetine – an SNRI antidepressant e.g. diabetic neuropathy, major depressive disorder
- Gabapentin – an anticonvulsant e.g. neuropathic pain
- Pregabalin – an anticonvulsant e.g. neuropathic pain
- Capsaicin cream (topical) – from chilli peppers e.g. localised neuropathic pain
a common side-effect of the long-term use of analgesic medication.
Medical overuse headache
side effects of NSAIDS
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- Hypertension
- Renal impairment
- Coronary artery disease,
- Gastritis with dyspepsia (indigestion)
- Stomach ulcers
- Exacerbation of asthma
- heart failure and strokes (rarely)
In patients with which conditions will NSAIDs be contraindicated in?
- Asthma
- Renal impairment
- Heart disease
- Uncontrolled hypertension
- Stomach ulcers
Proton pump inhibitors (e.g., omeprazole or lansoprazole) are often co-prescribed with NSAIDs to reduce the risk of gastrointestinal side effects (e.g., acid reflux, gastritis and stomach ulcers).
what are the key side effects of opiods?
- Constipation
- Skin itching (pruritus)
- Nausea
- Altered mental state (sedation, cognitive impairment or confusion)
- Respiratory depression (usually only with larger doses in opioid-naive patients)
What can be used to reverse the effects of opiods in life-threatening overdose (usually due to respiratory depression)
Naloxone is used to reverse the effects of opioids in life-threatening overdose (usually due to respiratory depression).
failure to thrive
list- Causes of Inadequate Nutritional Intake
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- Maternal malabsorption if breastfeeding
- Iron deficiency anaemia
- Family or parental problems
- Neglect
- Availability of food (i.e. poverty)
failure to thrive
list- Causes of Difficulty Feeding
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- Poor suck, for example due to cerebral palsy
- Cleft lip or palate
- Genetic conditions with an abnormal facial structure
- Pyloric stenosis
failure to thrive
list- Causes of Malabsorption
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- Cystic fibrosis
- Coeliac disease
- Cows milk intolerance
- Chronic diarrhoea
- Inflammatory bowel disease
failure to thrive
list- Causes of Increased Energy Requirements
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- Hyperthyroidism
- Chronic disease, for example congenital heart disease and cystic fibrosis
- Malignancy
- Chronic infections, for example HIV or immunodeficiency
failure to thrive
list- Inability to Process Nutrients Properly
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-Type 1 diabetes
how is BMI calculated?
BMI is calculated as: (weight in kg) / (height in meters)2.
what initial investigations should be taken in faltering growth?
Urine dipstick, for urinary tract infection
Coeliac screen (anti-TTG or anti-EMA antibodies)
Focused investigations should be considered where additional signs or symptoms suggest an underlying diagnosis, such as cystic fibrosis or pyloric stenosis.
