Pain

Question 1

what is the first step in the who pain ladder

Answer 1

paracetamol

Question 2

what is the max number of tablet/capsules that can be sold of paracetamol

Answer 2

32

pharmacist can sell 100 tabs

Question 3

what is the max daily dose for an adult for paracetamol

Answer 3

2g

Question 4

if a patients is receiving iv paracetamol what is the max dose

Answer 4

60mg/kg daily

Question 5

if a patient is less than 50kg and is receiving iv paracetamol what should the regiment be

Answer 5

15mg/kg qds

Question 6

what are the cautions for paracetamol

Answer 6

malnutrition
dehydration
alcoholism
liver impairment

Question 7

in what instances should the dose of paracetamol be reduced

Answer 7

renal impairment

<50kg if iv

Question 8

what medications does paracetamol interact with

Answer 8

st johns wart

warfarin

hepatotoxic meds

Question 9

if a patient overdoses on paracetamol what effects may they experience

Answer 9

abdominal pain

anorexia

nausea

vomitting

Question 10

what are symptoms of intense paracetamol overdose

Answer 10

jaundice

encephalopathy

hepatomegaly

coma

Question 11

how do we treat paracetamol overdose

Answer 11

N - acetyl - cysteine NAC IV

Question 12

in a patient who has overdosed on paracetamol what and when should we monitor

Answer 12

lfts every 24 hours

Question 13

name 5 different nsaids

Answer 13

ibuprofen
naproxen
diclofenac

celocoxib
etoricoxib

Question 14

what are ibuprofen.naproxen and diclofenac all examples of

Answer 14

non specific nsaids

Question 15

what are celocoxib and etoricoxib examples of

Answer 15

specific nsaids

Question 16

what is the mechanism of action of nsaids

Answer 16

inhibit cox1 and cox2

Question 17

what is the difference between a selective and non selective nsaid

Answer 17

targets cox2

Question 18

what are the contraindications of nsaids

Answer 18

history of previous/reccurant or active gi bleed or ulcer

hypersensitivity to aspirin or nsaids

Question 19

what are the cautions of nsaids

Answer 19

allergy

asthma

cardiac impairment or hf

dehydration

uncontrolled hypertension

Question 20

what does the use of nsaids increase the risk of

Answer 20

thrombotic events

gi bleed or ulcer

stroke

myocardial infarction

Question 21

which of the nsaids are most associated with increased risk of cardiovascular disease

Answer 21

highdose iburpfoen

highdose cox2

cox-2 inhibitors

Question 22

which of the nsaids is most associated with serious upper gi events

Answer 22

cox 2 inhibitors

Question 23

how do we go about dealing with the potential gi consequences

Answer 23

provide a ppi

Question 24

what are the main interactions of ibuprofen

Answer 24

lithium

ace inhibitors

diuretics

Question 25

should a pregnant women have ibuprofen?

Answer 25

no it is teratogenic especially in third trimester

Question 26

at what point of hepatic impairment should we stop the use of nsaids

Answer 26

severe

Question 27

when are opiates indicated

Answer 27

moderate to severe pain

Question 28

when should opiates be reviewed

Answer 28

MINIMUM ANUALLY

Question 29

what is the main ideaology around opiates

Answer 29

low dose for shortest time

Question 30

name three weak opioids

Answer 30

codeine dihydrocodeine low dose tramadol

Question 31

name some strong opiates

Answer 31

morphine diamorphine buprenorphine fentanyl alfentanil oxycodone

Question 32

what are some mhra risks

Answer 32

respiratory depression if opiates + benzos risk of dependence

Question 33

if a patient is on methadone what medicine can increase the chance of respiratory depression

Answer 33

benzos such as clonazepam

Question 34

what are the contraindication of opioids

Answer 34

acute respiratory depression patients in a coma head injury raised intracranial pressure

Question 35

what are the cautions of opioids

Answer 35

sleep apnoea elderly

Question 36

what are the main side effects patients experience with opioids

Answer 36

skin reactions confusion dizziness drowsiness euphoria hallucinations nausea vomiting constipation

Question 37

can a pregnant women use opioids

Answer 37

no as increased risk of respiratory depression and withdrawal symptoms

Question 38

what are the symptoms of overdose in opioids

Answer 38

coma resp depression pinpoint pupil

Question 39

what is the antidote for opioids

Answer 39

naloxone

Question 40

for what reason does naloxone need to be given in multiple doses

Answer 40

short duration

Question 41

what is a side effect of opioid reversal

Answer 41

severe pain