Pain

Question 1

First line for neuropathic pain

Answer 1

Amitriptyline and pregabalin (can be used in combination if patient has inadequate response to either drug at maximum tolerated dose).

Question 2

What is the maximum dose of amitriptyline that can be prescribed? A. Amitriptyline 75mg
B. Amitriptyline 100mg
C. Amitriptyline 150mg
D. Amitriptyline 50mg

Answer 2

(A) in major depressive disorder Amitriptyline 150mg is max

Question 3

Which agent is unlicenced in the use of neuropathic pain
A. Amitriptyline
B. Nortriptyline
C. Pregabalin
D. Morphine

Answer 3

B

Question 4

Which one must be initiated by specialist for the use in neuropathic pain management
A. Amitriptyline
B. Nortriptyline
C. Pregabalin
D. Morphine
E. Oxycodone

Answer 4

D and E

Question 5

What can be prescribed for neuropathic pain whilst the patient await an appointment with specialist.

Answer 5

**Tramadol **

Question 6

Which strength of capsaicin can be licensed for neuropathic pain and postherpetic neuralgia?

Answer 6

Question 7

What drug can be given IV in trigeminal neuralgia crisis?

Answer 7

A

Question 8

What NSAIDs are commonly indicated in the pain relief of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis and gout ?

Answer 8

Question 9

If there is knee involvement in osteoarthritis pain what agent is appropriate to prescribe?

Answer 9

Question 10

What is first line for pain relief in osteoarthritis?

Answer 10

Question 11

First line for pain management in Endometriosis (including duration)

Answer 11

Short trial of NSAIDs or paracetamol or in combination for 3 months.
Mefenamic acid may be considered here. //Diclofenac gel ibuprofen.

Question 12

What analgesic is indicated for abdominal pain or discomfort if patient has not responded to antispasmodics, antimotility or laxatives?

Answer 12

Amitriptyline-unlicensed use.

Question 13

Which agents should you NOT prescribe in the management of sciatica?

Answer 13

Do not offer gabapentinoids, other antiepileptics, oral corticosteroids or benzodiazepines for managing sciatica as there is no overall evidence of benefit and there is evidence of harm. [2020]

1.2.17. Do not offer opioids for managing chronic sciatica.

Question 14

First line for lower back pain

Answer 14

NSAIDs. Do not offer opioids for managing chronic low back pain or gabapentinoids.

Question 15

First line for diverticulitis

Answer 15

Often associated with inflammation of bowel causing pain and discomfort and rectal bleeding therefore NSAIDs are not appropriate choice.
First line: Paracetamol

Question 16

Paroxysmal Hemicrania
What are the defining symptoms?
Are there any associated causes?

Answer 16

Attacks are more frequent than cluster headaches.
However response to Indomethacin.

Question 17

Cluster headaches
What are the defining symptoms?
Are there any associated causes?
Where is the headache located?
How long must the headache last for in episode?

Answer 17

Question 18

Tension Headache
What are the defining symptoms?
Are there any associated causes?
Where is the headache located?
How long must the headache last for in episode?

Answer 18

Question 19

Μigraine
What are the defining symptoms?
Are there any associated causes?
Where is the headache located?
How long must the headache last for in episode?

Answer 19

Question 20

What is classes as medication overuse headache and what medications are commonly observed here?

Answer 20

Triptans, opioids, ergot or combination analgesic medications on 10 days/month
Or
Paracetamol, aspirin or NSAID either alone or in combination, on 15 days per month or more.

Question 21

First line for acute treatment of cluster headaches

Answer 21

Note: do not recommend the use of paracetamol, nonsteroidal anti-inflamm

Question 22

First line for tension headache

Answer 22

Analgesia for mild to moderate pain are:
Paracetamol
NSAIDS
Aspirin

Question 23

First line and second line for acute migraine and then prophylaxis

Answer 23

Prophylaxis: Beta blocker-propranolol

Question 24

What is the licensing for Sumatriptan and dose for the said age group?

Answer 24

> 12 years (10 mg nasal spray of sumatriptan)

<not licensed for over 65 years.

Question 25

What would you give to migraine user is vomiting restricts their intake of medicine?

Answer 25

Melt preparation or intranasal spray of SC injection.

Question 26

What antiemetic is indicated in acute treatment of migraine?

Answer 26

Metoclopramide Prochlorperazine.

Question 27

When are triptans inappropriate to prescribe?

Answer 27

Cardiovascular disorder Cerebrovascular disorder Severe hepatic impairment MAO-I

Question 28

What are the adverse effects of Triptans?

Answer 28

NS: Drowsiness and dizziness RS: Dyspnoea GI: Nausea and vomiting With intranasal use: epistaxis

Question 29

For breastfeeding ladies on sumatriptan how should they avoid the exposures to infant? A. 4 hours B. 6 hours C. 12 hours D. 3 hours

Answer 29

C

Question 30

What is the dose that should be considered in treatment of migraine associated with headache nausea or vomiting? A. 10mg Prochlorperazine and Metoclopramide B. 20 mg Prochlorperazine and 10 mg Metoclopramide C. 30 mg Metoclopramide and 10 mg Prochlorperazine D. 10 mg Metoclopramide and 20 mg Prochlorperazine

Answer 30

A.

Question 31

# ``` ``` What is the licensing for Metoclopramide and Prochlorperazine?

Answer 31

Prochlorperazine: >12 years of age. Metoclopramide: not licensed.