Chapter 4 - Pain Flashcards Preview

Pharmacy Pre-Reg 2020/2021 > Chapter 4 - Pain > Flashcards

Flashcards in Chapter 4 - Pain Deck (204)
Loading flashcards...
1

What is the difference between acute and chronic pain?

Acute - less than 12 weeks
Chronic - more than 12 weeks

2

How is pain managed in children under 16 years?

Paracetamol or ibuprofen
Switch to the other
Alternate between both

3

How frequently is paracetamol given?

Every 4-6 hours
Maximum 4 doses per day

4

How frequently is ibuprofen given?

Every 8 hours

5

Describe the who analgesic ladder

Step 1. Non-opioids
Step 2. Mild opioids
Step 3. Strong opioids

6

How frequently should analgesics be reviewed in chronic pain?

At least annually

7

Is paracetamol:
a)antipyretic
b) anti inflammatory
c) analgesic

a and c

8

What is the maximum recommended paracetamol dose in

a) >50 kg
b) <50 kg

a) 4g
b) 2g

9

Why is paracetamol preferred over NSAIDs, especially in the elderly?

Less irritating to the stomach

Less CV and GI complications

10

What is the maximum pack size of paracetamol that can be sold to the public?

32

11

What is the maximum number of paracetamol tablets/capsules that can be sold to the public?

100

12

What are the dangers associated with paracetamol overdose?

Hepatocellular necrosis
Renal tubular necrosis (less common)

13

What single dosage of paracetamol may cause hepatocellular necrosis?

Generally 10g, or 75mg/kg taken in less than 1 hour
Or 5g if risk factors are present

14

What are the risk factors for paracetamol overdose?

Alcohol dependency
Malnutrition
Chronic dehydration
Body weight <50kg
Severe liver disease
Increasing age
Concomitant use of hepatic enzyme inducers e.g. rifampin, phenytoin

15

What are the symptoms associated with paracetamol overdose?

Initially nausea and vomiting
Liver related side effects may occur later

16

How is paracetamol overdose managed?

If above the treatment line, use IV acetylcysteine

17

How soon should acetylcysteine ideally be given in paracetamol overdose?

Within 8 hours

18

NSAIDs have a strong anti-inflammatory action?

Ketoprofen
Piroxicam

19

NSAIDs have a moderate anti-inflammatory action?

Ibuprofen, naproxen

20

What is the mechanism of action of NSAIDs?

Inhibit COX-1 and COX-2

21

What is the effect of inhibiting COX-1 enzymes?

GI irritation due to reducing prostaglandin production

Inhibiting platelet aggregation due to reducing the production of thromboxane A2, so increasing the risk of bleeding

Regulates GFR

22

What is the effect of inhibiting COX-2 enzymes?

Reduces pain
Reduces inflammation
Reduces fever

23

What is the main advantage of selective NSAIDS over non-selective NSAIDs?

Reduced GI side effects

24

What is the main disadvantage of selective NSAIDS over non-selective NSAIDs?

Increased cardiovascular side effects

25

If a patient with CVD risk factors requires and NSAID, what should be given?

Non-selective NSAID + PPI

26

Give some examples of non-selective NSAIDs

Ibuprofen
Naproxen
Mefanamic acid
Diclofenax
Meloxicam

27

Give some examples of selective NSAIDs

Celecoxib
Etoricoxib

28

Why should NSAIDs be taken with food?

To reduce gastric irritation

29

List some side effects of NSAIDs

GI side effects
CV side effects
Renal impairment
Fluid retention
Bronchospasm in some patients

30

Which NSAIDs have the highest risk of GI side effects?

Piroxicam
Ketoprofen