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BNF CNS > Pain > Flashcards

Pain Flashcards

1
Q

How long must pain be present for to be class as chronic pain?

A

12 weeks

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2
Q

Non-drug treatment of pain

A

Exercise, Transcutaneous electrical nerve stimulation, pain management programes (CBT)

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3
Q

Examples of non opioid analgesics

A

Paracetamol, NSAIDS, topical applications (capsaicin / lidocaine), Rubefacients

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4
Q

Above what dose of opioids should pain specialist advice be sought?

A

> 90mg/day morphine or equivalent

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5
Q

Which analgesic class is best suited for musculoskeltal pain?

A

Non-opioids e.g. paracetamol, NSAIDS and aspirin

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6
Q

Which analgesic class is best suited for visceral pain?

A

opioid analgesia

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7
Q

For dental pain e.g. plpitis jow long should analgesia be used for?

A

Max of 7 days - provides a temporary measure until the source is treated

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8
Q

What medication can be used to treat pain of the oral mucosa e.g. acute herpetic gingivotomastis?

A

Benzydamine hydrochloride mouthwahs/ spray

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9
Q

Which analgesic has antipyretic and pain relief effects but not anti-inflammation?

A

Paracetamol

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10
Q

Are opioids effective in dental pain?

A

No

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11
Q

What types of pain is aspirin indicated for?

A

headache, transient musculoskeletal pain, dysmenorrhea, pyrexia

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12
Q

When should aspirin be taken?

A

After food

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13
Q

What class of analgesia is useful to help with secondary bone tumours?

A

NSAIDS

bone tumours produce lysis of bones and release prostagladins

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14
Q

An example of an non-opioid intrathecal analgesic used for chronic severe pain

A

Ziconotide

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15
Q

Opiod side effects

A

Constipations, drowsiness, nausea, vommiting, respiratory depression, dependence

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16
Q

Which analgesic has both opioid agonist and antagonist properties

A

Buprenorphine

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17
Q

How long can buprenorphine sublingual last?

A

6 to 8 hours

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18
Q

Can naloxone fully reverse the effects of Buprenorphine?

A

No - only partially reverse the effects

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19
Q

Diamorphine causes less nausea and hypotension thta what other analgesic?

A

Morphine

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20
Q

how often must a fentanyl patch be changed?

A

every 72 hours

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21
Q

What is a benefit of Methadone over morphine

A

less seadating (and long half life)

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22
Q

What is the maximum frequency methadone can be given?

A

BD

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23
Q

what is the medication used as analgesia in labour?

A

Pethidine

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24
Q

how does Tapentadol produce analgesia?

A
  1. opioid effect

2. NA reuptaking inhibtion

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25
Q

How does Tramadol produce an analgesic effect?

A

opiod effect and enhancement of serotonergic and adrenergic pathways

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26
Q

What is Meptazinol?

A

A weak opioid - onest of 15 mins and duration of 2-7 hours

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27
Q

Side effects of opioids given via Epidural

A

pruritus, urinary retention, nausea & vomiting

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28
Q

If a patient has heptotoxicity risk factors what is the dose of IV paracetamol?

A

up to 50kg: 15mg/kg

>60kg 1g 4 to 6 hourly (max 3g) `

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29
Q

Paracetamol dosing for a 3 - 5 month year old

A

60mg 4 to 6 hourly (2.5mL of 120mg/5mL)

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30
Q

Paracetamol dosing for a 6-23 month year old

A

120mg 4 to 6 hourly 4 to 6 hourly (5mL of 120mg/5mL)

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31
Q

Paracetamol dosing for a 2 - 3 year old

A

180mg 4 to 6 hourly (7.5mL of 120mg/5mL)

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32
Q

Paracetamol dosing for a 4-5 year old

A

240mg 4 to 6 hourly (10mL of 120mg/5mL)

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33
Q

Paracetamol dosing for a 6-7 year old

A

240-250mg 4 to 6 hourly

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34
Q

Paracetamol dosing for a 8-9 year old

A

360-375mg 4 to 6 hourly (15mL of 120mg/5mL)

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35
Q

Paracetamol dosing for a 10 to 11 year old

A

480-500mg 4 to 6 hourly

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36
Q

Paracetamol dosing for a 12 - 15 year old

A

480-750mg 4 to 6 hourly

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37
Q

Paracetamol dosing for a 1 - 2 month year old

A

30-60mg 8 hourly

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38
Q

Paracetamol dosing for a 3-5 month year old

A

60mg every 4-6 hours

39
Q

What age is paracetamol 500mg/5mL suspesion not licesend for use in?

A

<16 year olds

40
Q

What is the risk od combining opioids and Benzodiazepines?

A

Risk of respiratory depression (MHRA alert)

41
Q

How can respiratory depression be treated?

A

Naloxone

42
Q

What are some symptoms of opioid overdose?

A

Coma, respiratory depression, pinpoint pupils

43
Q

If a patient is to switch from methadone to Buprenoprhine, what must the dose of Methadone be at a maximum of?

A

30mg

44
Q

If a patient is on >10mg methadone and is to start on sublingual buprenorphine what dose should they start at?

A

4mg (if methadone <10mg, start at 2mg)

45
Q

How many buprenorphine patches can be applied at one time?

A

maximum of 2

46
Q

How long may it take for plasma-buprenorphine concentration to decrease by 50% after a BUPEAZE, RELEVTEC or BUPLAST is removed?

A

30 hours

47
Q

How long may it take for plasma-buprenorphine concentration to decrease by 50% after a BUTEC, PANITAZ, RELETRANS, SEVODYNE or BUPRAMYL is removed?

A

12 hours

48
Q

Which Buprenorphine patches should be worn for 96 hours

A

Relevtec, Transtec, Buplast, Bupeaze

49
Q

Which Buprenorphine patch can be worn for 7 days

A

Bupramyl, Panitaz, Reletrans , Sevodyne, Butrans

50
Q

Buprenorphine patches that should be applied 72 hourly

A

Hapoctasin and Prenotrix

51
Q

If cocodamol is prescribed but no strength is stated, what should be dispensed?

A

8/500mg strength

52
Q

How old must a child be to have codeine?

A

> 12

53
Q

What is the maximum daily dose of codeine in children aged 12-18?

A

240mg (dose inervals of 6 hourly) and limited to 3 days of treatment

54
Q

If a patient age <18 has their tonsils removed or adenoids, can codeine be prescribed for pain>

A

No - risk of obstructive sleep aponea

55
Q

Can codeine be used in breastfeeding?

A

No

56
Q

If an obese patient requires fentanyl, what weight should be calculated?

A

IBW

57
Q

Can fentanyl patches be cut?

A

NO

58
Q

if a patient with a fentanyl patch has a fever, why is it important to monitor them?

A

increased temperature can increase the absorption and therefore make patient more suceptible to side effects

59
Q

How oftne should a fentanyl patch be changed?

A

72 hours

60
Q

How should buccal fentanyl be administered?

A

Hold against inside of cheek for at least 5 seconds until it sticks and leave to dissolve (15-30mins). Avoid oral liquids for 5 mins and avoid food until dissolved

61
Q

Are fentanyl lozenges (lollipops) suitable for diabetics

A

No - contain 2g sugasr

62
Q

What age are oramorph and MXL capsules not licensed for?

A

<1 yeasr

63
Q

What age is Sevredol licensed for use in?

A

> 3 years

64
Q

Oramorph unit dose vials are not licensed for children under what age?

A

6 years

65
Q

12 hourly morphine preparations

A

Filnarine SR, MST continus, Morphgesic SR, Zomorph

66
Q

24 hour morphine preparation

A

MXL

67
Q

What is the conversion of oral oxycodone to parenteral oxycodone?

A

PO 2mg = 1mg Parenteral

68
Q

12 hourly oxycdone preparatio exmaples

A

Longtec, Oxycontin, Oxypro, Oxylan, Reltebon, Abtard, Carexil, Ixyldone, Leveraxo

69
Q

What is the MHRA alert regarding Tapentadol

A

Risk of seizures and reports of serotonin syndrome hen co-prescribed other medications

70
Q

Can tramadol be used in epilepsy

A

No - lowers seizure threshold

71
Q

What drug classes can be used to treat neurpathic pain?

A

TCAs (amitriptyline) and antiepileptic drugs (pregabalin, Gabapentin)

72
Q

What cream can be used in post herpetic neuralgia?

A

Capsaicin

73
Q

What drug class can help to relieve pressure in compression neuropathy and thereby reduce pain?

A

Corticosteroids

74
Q

What antiepileptic can be used for trigeminal neuralgia

A

Carbamazepine

75
Q

What type of antidepressant drug can be used to manage facial pains

A

TCAs

76
Q

What is an example of a weak opioid of choice in renal impairment?

A

Meptazinol

77
Q

Signs of opioid withdrawl

A

nausea, vomiting, sweating,restlessness, agitation. dilated pupils, bone and muscle pain, Gooseflesh, abdominal cramps

78
Q

How can withdrawl be treated?

A

Switch to long acting opioid (bupren/methadone) and slowly reduce dose over time

79
Q

Dose of Carbamazepine in TGN

A

100mg BD

80
Q

What analgesia should be offerent for lower back pain?

A

NSAID (paracetamol alone will not suffice) only add in opioid if not controlled

81
Q

What NSAID has a lower risk of DV / thrombotic effects?

A

Naproxen 1g a day

82
Q

What type of NSAIDS have a lower risk of GI side effects

A

COX 2 inhibitors

83
Q

NSAIDs with the highest risk of GI side effects

A

piroxicam, ketoprofen, ketorolac, trametamol

84
Q

NSAIDS with an intermediate risk of GI side effects

A

Naproxen, indomethacin, diclofenac

85
Q

NSAID with lowest risk of GI side effect

A

Ibuprofen

86
Q

what can be given to alleviate cluster headache

A

Sumatriptan SC (or nasal spray)

87
Q

What medications can be used as propylaxis agaisnt cluster headaches?

A

Verapamil, Lithium, Prednisolole (short term)

88
Q

Pizotifen is a sedating antihistamine that can be used to manage what neurological condition?

A

headache / migraine

89
Q

Migraine symptoms

A

Unilateral headache, pulsating, accompained with N&V photophobia

90
Q

How many days shoulg migraine treatment be restricted to in order to prevent medication overuse headache

A

2 days

91
Q

First line monotherapy for migraine attack

A

Aspirin or Ibuprofen or 5HT1 agonist

92
Q

First line medication for preventative treatment in patients with episodic or chronic migraine

A

Propanolol (can also use topiramate, Bisoprolol, Amitriptyline, Candesartan

93
Q

When can botoc be used as migraine prophylaxis

A

When medication overuse has been addressed and 3 or more oral propylactic treatments have failed

94
Q

Drug composition of Migraleve tablets

A

Paracetamol with buclizine and codeine

pink = paracetamol + codeine Yellow = buclizine

BNF CNS (9 decks)

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