Pain Management

Question 1

Mild pain treatment

Answer 1

non-opioid analgesics:
- paracetamol
- NSAID’s
- high dose aspirin (300mg)

Question 2

Mild - moderate pain treatment

Answer 2

non-opioid analgesic + weak opioid (codeine, tramadol, dihydrocodeine)

Question 3

moderate-severe pain

Answer 3

non-opioid analgesic + weak opioid + strong opioid (morphine, oxycodone, methadone, fentanyl, dihydromorphine)

Question 4

codeine side-effects

Answer 4

constipation, nausea and drowsiness

Question 5

codeine warnings

Answer 5

• not for <12 y/o, 12-18 only if paracetamol and ibuprofen haven’t worked
• no longer than 3 days OTC use
• contraindicated in children <18 who have had tonsils removed due to sleep apnoea
• not to be used in children with breathing issues
• contraindicated in ultra-rapid metabolizers (Afro-Caribbean)
• avoid in breastfeeding as passed through milk

Question 6

tramadol side effects

Answer 6

nausea and dizziness

Question 7

tramadol warnings

Answer 7

• risk of addiction and dependence
• not recommended in pregnancy
• do not operate heavy machinery if it has altered your alertness
• may cause serotonin syndrome

Question 8

fentanyl patch application

Answer 8

• change patch every 72 hours
• avoid exposure to heat
• apply to dry skin with trimmed hair and no irritation
• remove patch immediately when signs of toxicity occur (muscle stiffness or fatigue)
• do not cut patches
• use on torso or upper arm and rotate site
• not to be used in opioid naive patients

Question 9

opioid MHRA warnings

Answer 9

• risk of fatal respiratory depression
• risk of dependence and addiction

Question 10

opioid antidote

Answer 10

Naloxone

Question 11

breakthrough opioid dose

Answer 11

1/6th - 1/10th of their total daily dose every 2-4 hours (max 6 times a day)

Question 12

Morphine daily increase

Answer 12

Should not exceed 1/2 to 1/3 of total daily dose every 24 hours

Question 13

neuropathic pain treatment

Answer 13

TCA: amitriptyline or noritriptyline

antiepileptics: carbamazepine, gabapentin or pregabalin

SNRI: duloxetine

opiates: tramadol

topical localised: capsaicin or lidocaine plasters

Question 14

pregabalin warning

Answer 14

increased risk of major congenital malformations - avoid in pregnancy, use contraception

Question 15

MS relapse treatment

Answer 15

methylprednisolone

Question 16

What is the strength of the infant paracetamol liquid?

Answer 16

120/5ml

Question 17

paracetamol dose for child aged 3-5 months

Answer 17

2.5ml of 120/5ml (Max QDS in 24hrs)

Question 18

paracetamol dose for child aged 6-23 months

Answer 18

5ml of 120/5ml (Max QDS in 24hrs)

Question 19

paracetamol dose for child aged 2-3 years

Answer 19

7.5ml of 120/5ml (Max QDS in 24hrs)

Question 20

Paracetamol dose for child aged 4-5 years

Answer 20

10ml of 120/5ml (max QDS in 24 hours)

Question 21

what is the strength of the 6+ paracetamol syrup?

Answer 21

250mg/5ml

Question 22

what dose of the the 6+ paracetamol syrup can be given to those aged 6-7?

Answer 22

5ml (Max QDS in 24hrs)

Question 23

what dose of the the 6+ paracetamol syrup can be given to those aged 8-9?

Answer 23

7.5ml (max QDS in 24 hours)

Question 24

what dose of the the 6+ paracetamol syrup can be given to those aged 10-11?

Answer 24

10ml (max QDS in 24 hours)