Drugs: Pain + Nausea

Question 1

SOCRATES Mnemonic for Pain

Answer 1

Site
Onset
Character
Radiation
Associated symptoms
Time/ duration
Exacerbating + relieving factors
Severity

Question 2

1st line management for chronic neuropathic pain

Answer 2

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

Question 3

1st line “rescue therapy” for acute exacerbations of neuropathic pain

Answer 3

Tramadol

Question 4

1st line for Trigeminal neuralgia

Answer 4

Carbamazepine

Question 5

Management for post-herpetic neuralgia

Answer 5

Localised pain: Topical capsaicin cream

Question 6

Burning pain
Shooting pain
Numbness (pins and needles)
Not localised

Answer 6

Neuropathic pain

Question 7

Sharp pain
Dull pain
Localised

Answer 7

Nociceptive pain (body responding to damage)

Question 8

Paracetamol dosage for kids

Answer 8

15mg/kg in kids

Question 9

Paracetamol is absorbed in the

Answer 9

proximal small bowel

- 20 to 60mins onset

Question 10

Take paracetamol levels at

Answer 10

4 hours to allow maximum absorption

Question 11

Time to effect of IV morphine

Answer 11

5 mins for 85%

15 mins for 100% effectiveness

Question 12

10mg Oramorph lasts

Answer 12

4-6 hours

Question 13

10mg MST lasts

Answer 13

12 hours

Question 14

Anticipated medications for end of life

Answer 14

Morphine
Midazolam
Levomepromazine
Buscopan

No fluids (worsens resp secretions)

Question 15

If pain is not controlled by morphine

Answer 15

increase dose by 30 - 50%

Question 16

When switching Morphine > Oxycodone

Answer 16

divide by 2

Question 17

When switching oral Morphine > s/cut Morphine

Answer 17

divide by 2

Question 18

When switching oral Morphine > s/cut Diamorphine

Answer 18

divide by 3

Question 19

When switching oral Oxycodone > s/cut Diamorphine

Answer 19

divide by 1.5

Question 20

Breakthrough dose of morphine =

Answer 20

1/6th of daily morphine dose

Question 21

When switching Codeine > Morphine

Answer 21

divide by 10

Question 22

When switching Tramadol > Morphine

Answer 22

divide by 10

Question 23

Analgesia in renal impairment

Answer 23

1. Fentanyl
2. Buprenorphine
3. Alfentanil

Excreted via liver

Question 24

Management of acute agitation

Answer 24

1. Haloperidol
2. Chlorpromazine
3. Levomepromazine

Question 25

Management of terminal agitation

Answer 25

Midazolam

Question 26

Management of hiccups at end of life

Answer 26

1. Chlorpromazine

2. Haloperidol

Question 27

Management of metastatic bone pain

Answer 27

1. Analgesia
2. Biphosphonates
3. Radiotherapy

Question 28

Management of respiratory secretions at end of life

Answer 28

Hyoscine hydrobromide

Question 29

Management of bowel colic at end of life

Answer 29

Hyoscine butylbromide (buscopan)

Question 30

Management of oral/throat pain at end of life

Answer 30

Benzydamine hydrochloride

Question 31

Management of nausea + vomiting at end of life

Answer 31

Levomepromazine

- long acting (8 - 12 hours)

Question 32

Management of gastric nausea

Answer 32

Metoclopramide

• D2 receptor antagonist
• prokinetic (promotes peristalsis)

Question 33

Side effects of metoclopramide

Answer 33

Extra pyramidal side effects

Question 34

Management of extra-pyramidal side effects

Answer 34

Domperidone

Question 35

Management of nausea from chemotherapy

Answer 35

Ondansetron

• Serotonin receptor antagonist
• acts on medulla oblongata

Question 36

Side effects of ondansetron

Answer 36

“drys you up”

- constipation etc

Question 37

Management for nausea due to intra-cranial pathology

Answer 37

1. Dexamethasone
   - reduces oedema around tumours
2. Cyclizine (for vomiting)