Analgesics

Question 1

What are the WHO pain ladder recommendations?

Answer 1

1. Non Opioid +/- adjuvants
2. Weak opioid + non opioid +/- adjuvants
3. Strong opiod + non opioid +/- adjuvants

Question 2

What are the two types of non opioid?

Answer 2

1. Paracetamol
2. NSAIDS

Question 3

How does paracetamol work and what is it used for?

Answer 3

Unknown mechanism

Reduces central prostaglandin synthesis - negligible anti inflammatory action

Question 4

What is the main concern with paracetamol?

Answer 4

Overdose as it is so readily available

All the glutathione gets used - give n acetylcystein

Question 5

What does paracetamol react with and who should not take it?

Answer 5

Nothing and no one

Question 6

How do NSAIDS work?

Answer 6

Block COX enzymes

COX 1 - Gastroprotection, renal perfusion, platelet aggregation

COX 2- Inflammation and pain

Question 7

What are the side effects of NSAIDS?

Answer 7

GI bleeds and problems

Kidney damage

Bronchospasm

Na, H20 retention

MI

This is because cant cause the drug to only block COX 2 and not COX 1

Question 8

What are some weak opioids?

Answer 8

Codein

Dihydrocodeine

Question 9

What is an intermediate opiate?

Answer 9

Tramadol

Question 10

What are some strong opioids?

Answer 10

Fentanyl

Morphine

oxycodone

Question 11

How do opiates work?

Answer 11

Stimulate centres in the brain for endogenous opiates and have direct effects

Question 12

What are some non pain reducing side effects of opiates?

Answer 12

Constipation

Euphoria

Sedation

Respiratory/cough supression

Question 13

What is an opiate reverser?

Answer 13

Naloxone

Question 14

What opiate receptors are there?

Answer 14

Mew

Kappa

Delta

Mew - Mophine, fentanyl

All - Oxycodone

Question 15

Alternatives - When would you use bisphosphonates?

Answer 15

Bone pain, eg cancer mets

Stops bone resorption

Question 16

Alternatives - When would you use baclofen?

Answer 16

Muscle spasm pain

Question 17

Alternatives - What is an NMDA antagonist used for pain?

Answer 17

Ketamine - used post operatively or in trauma

Question 18

Alternatives - What are some anaesthetics?

Answer 18

Lidocaine - Blocks AP potential via blocking sodium channels

Entonox - NO and o2 - Child birth

Question 19

Alternatives - anti epileptic

Answer 19

Carbamazepine - Trigeminal neuralgia

Question 20

Alternatives - Cream

Answer 20

Capsaicin - causes over sensitization and dying back of sensory nerves

Question 21

What must be written down on discharge medicine for opiates?

Answer 21

Name and address handwritten

Specify dose/strength/form

State quantity in words and figures

SEE lecture handout

Question 22

What is 1st line for diabetes pain?

Answer 22

Duloxetine

Question 23

What is 1st line for trigeminal neuralgia?

Answer 23

Carbamazepine