Pain Flashcards
(31 cards)
1
Q
What are the main classes of non-opioid analgesics used in hospital settings?
A
- Paracetamol (acetaminophen)
- NSAIDs (e.g., ibuprofen, naproxen, diclofenac)
- Adjuvant medications (e.g., antidepressants, anticonvulsants, topical agents)
2
Q
How does paracetamol work as an analgesic?
A
- Acts centrally by inhibiting prostaglandin synthesis in the brain
- Reduces fever and provides mild to moderate analgesia
- Minimal anti-inflammatory properties
3
Q
What are the benefits of using paracetamol in pain management?
A
- Safe, well-tolerated, minimal side effects
- Can be combined with other analgesics for synergistic effect
- Suitable for most patients including the elderly and those with mild liver dysfunction
4
Q
What are the potential risks of paracetamol overdose?
A
- Hepatotoxicity
- Risk increases with chronic alcohol use, malnutrition, or accidental cumulative dosing
- Treated with N-acetylcysteine (NAC)
5
Q
How do NSAIDs exert their analgesic effect?
A
- Inhibit cyclooxygenase (COX) enzymes
- Reduce prostaglandin production
- Provide anti-inflammatory, analgesic, and antipyretic effects
6
Q
What are the main side effects of NSAIDs?
A
- Gastric irritation, ulcers, and bleeding
- Renal impairment
- Increased cardiovascular risk
- Fluid retention and hypertension
7
Q
Which patients should avoid NSAIDs?
A
- Those with active GI ulcers or bleeding
- Patients with chronic kidney disease (CKD)
- Uncontrolled hypertension or heart failure
- Those on anticoagulation (e.g., warfarin)
8
Q
What are adjuvant medications for pain and when are they used?
A
- Medications not primarily designed for pain but help manage specific types
- Examples: Amitriptyline (neuropathic pain), Gabapentin (nerve pain), Capsaicin cream (topical)
- Useful for chronic, neuropathic, or cancer-related pain
9
Q
What is a multimodal approach to pain management?
A
- Combining different classes of medications with complementary mechanisms
- Targets multiple pathways of pain processing
- Enhances efficacy and reduces reliance on opioids
10
Q
What is the WHO analgesic ladder?
A
- Stepwise approach to pain management:
- Mild pain: Non-opioids (e.g., paracetamol, NSAIDs)
- Moderate pain: Weak opioids ± non-opioids
- Severe pain: Strong opioids ± adjuvants ± non-opioids
11
Q
What are common examples of weak opioids?
A
- Codeine
- Tramadol
- Dihydrocodeine
- Often used for moderate pain, sometimes combined with paracetamol
12
Q
What are the side effects of codeine?
A
- Constipation
- Nausea and vomiting
- Drowsiness
- Potential for dependence and respiratory depression
13
Q
How does tramadol differ from other opioids?
A
- Weak μ-opioid receptor agonist
- Inhibits serotonin and norepinephrine reuptake
- May lower seizure threshold and cause serotonin syndrome
14
Q
Which strong opioids are commonly used in hospitals?
A
- Morphine
- Oxycodone
- Fentanyl
- Hydromorphone
15
Q
What are signs of opioid toxicity?
A
- Miosis (pinpoint pupils)
- Respiratory depression
- Reduced level of consciousness
- Bradycardia and hypotension
16
Q
What is naloxone and how is it used?
A
- Opioid antagonist
- Reverses opioid toxicity effects (respiratory depression)
- Administered IV or IM, may require repeated dosing
17
Q
What strategies help minimize opioid use in acute pain?
A
- Use multimodal analgesia
- Set clear expectations on duration
- Review pain scores and wean early
- Prescribe laxatives with opioids
18
Q
What is opioid-induced constipation and how is it managed?
A
- Common side effect due to reduced GI motility
- Managed with stimulant laxatives ± osmotic agents
- Prophylactic laxatives recommended
19
Q
What are the risks of chronic opioid therapy?
A
- Tolerance and dependence
- Endocrine dysfunction
- Opioid-induced hyperalgesia
- Cognitive impairment
20
Q
How do you convert between oral and parenteral morphine?
A
- IV morphine is approximately 3 times more potent than oral
- Oral dose ÷ 3 = approximate IV dose
- Always use opioid conversion charts
21
Q
What are the principles of safe opioid prescribing?
A
- Use the lowest effective dose for the shortest duration
- Regularly reassess pain and side effects
- Document indication and plan
- Avoid PRN-only regimens in severe pain
22
Q
What is PCA and when is it used?
A
- Patient-Controlled Analgesia
- Allows patient to self-administer preset doses
- Used in post-operative and cancer pain
23
Q
What is opioid rotation and when is it considered?
A
- Switching to another opioid due to side effects or lack of efficacy
- Requires equianalgesic dose calculations
- Titrate cautiously
24
Q
What are red flags in a patient on opioids?
A
- Reduced respiratory rate
- Decreased consciousness
- Uncontrolled pain despite increasing doses
- No bowel movement for >3 days
25
What pain conditions typically respond poorly to opioids?
- Neuropathic pain
- Functional pain syndromes
- Fibromyalgia
- Headaches
26
What is the role of topical analgesics in pain management?
- Provide local pain relief with fewer systemic effects
- Examples: Lidocaine patches, capsaicin cream
- Useful in neuropathic or localized musculoskeletal pain
27
What is pain catastrophizing?
- Negative cognitive and emotional response to pain
- Can amplify pain perception
- Addressed through psychological support and CBT
28
What are some non-pharmacologic interventions for pain?
- Heat/cold therapy
- Physiotherapy
- Psychological interventions (CBT, mindfulness)
- TENS units
29
What is the difference between nociceptive and neuropathic pain?
- Nociceptive: due to tissue injury (e.g., fracture, arthritis)
- Neuropathic: due to nerve damage (e.g., diabetic neuropathy)
30
Why is regular pain reassessment important in hospital patients?
- Ensures effective treatment
- Identifies side effects or complications
- Allows timely adjustments in analgesia plan
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