Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clinical pharmacology and therapeutics > Pain management > Flashcards

Pain management Flashcards

(72 cards)

Start Studying
1
Q

Why should you not mix types of opioids?

A

Difficult to assess which is causing the side effects, titrate the dose and difficult to determine which is effective

Increases side effects due to different side effect profiles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List some examples of NSAIDs

A

Naproxen

Ibruprofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List some examples of opioids

A

Tramadol
Codeine in co-codamol
Fentanyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List some ant epileptic neuropathic pain agents

A

Pregabalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List some antidepressent neuropathic pain agents

A

Amitriptyline

Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name a benzodiazepine

A

Diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What must you do if a drug is ineffective?

A

Stop the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which acryonm is use in essential pain management?

A

Recognize
Assess
Treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What challenges may you face in recognizing a person has pain?

A

Does this person have pain?
May have learning difficulties or dementia or may not be able to communicate effectively
Look for subtle signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can change how we perceive pain?

A 
Culture 
Beliefs
Psychological factors 
Other illness 
Personality 
Social factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you assess pain?

A

SOCRATES

Verbal or visual rating scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why is it important to assess pain?

A

Affects treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is visceral pain?

A

Pain felt in organs that are sensitive to stretch, ischaemia and inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give some examples of somatic pain

A

Broken bones

Muscle sprains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What pain do peripheral nerve blocks help with?

A

Somatic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What pain do central nerve blocks help with?

A

Visceral pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does inflammatory pain present?

A

Throbbing, aching, localised to the affected area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which drugs work best on inflammatory pain?

A

NSAIDs

Paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does nociceptive somatic pain present?

A

Sharp pain and localised to the area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which drugs work best on nociceptive somatic pain

A

NSAIDs
Opioids
Paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does nociceptive visceral pain present?

A

Deep, aching, poorly localised and cramping pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which drugs work best on nociceptive visceral pain?

A

NSAIDs
Paracetamol
Opioids
Neuropathic agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does neuropathic pain present?

A

Shooting, burning, hypersensitive, tingling, numbing pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name some treatments for migraines

A

Triptans
Propranolol
Pizotifen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Name some treatments for trieminal neuralgia
Carbamazepine
26
What class of drug is triptan?
5HT1 receptor agonist
27
What class of drug is pizotifen?
antihistamine
28
What drugs are used to treat mixed neuropathic and nociceptive pain?
Multimodal approach
29
Describe acute pain
Warning sign or injury Well defined onset <6 months Responds well to treatment - should be treated promptly and stepped up readily Generally produces anxiety Often associated with physical sins - tachycardia, tachyponea and decreased immunity and well being
30
Describe chronic pain
Persists beyond expected healing time May or may not have defined onset Often difficult to treat - better to prevent Can have psychological element Pain signals remain active in nervous system for weeks or months or years Progressive physical deterioration Impacts on quality of life
31
What pain management does acute pain respond well to?
Conventional analgesics - Paracetamol, NSAIDs, opiods
32
What pain management does chronic pain respond well to?
Neuropathic agents Psychological therapies Pain education Non pharmacological treatments
33
Describe how acute on chronic pain should be treated
Short term treatment with conventional analgesics plus their regular analgesics Can be complicated by increased tolerance and hypersensitivity to pain
34
What are the simple analgesics?
NSAIDs | Paracetamol
35
What are the opiods?
Weak or strong
36
What are the neuropathic agents?
Anticonvulsants - gabapentin, pregabalin, carbamazepine | Antidepressants - amitriptyline, duloxetine
37
Describe the WHO pain ladder for acute pain
Step 1 - non opioids Step 2 - Mild opioids Step 3 - Strong opioid Step 4 - Nerve blocks, Patient controlled analgesia pumps
38
Where do you start on the WHO pain ladder in surgical pain?
Start relative to pain severity and move down the ladder
39
What is the usual dose of paracetamol
1g QDS PO/IV If pt is <50Kg, 500mg QDS PO/IV Max 15mg/KG IV
40
What is the usual dose of ibruprofen?
400mg TDS PO
41
What is the usual dose of naproxen?
250-500mg BD PO
42
What is the risk of prescribing NSAIDs?
GI bleeds | Cardiovascular side effects
43
Which is stronger: Naproxen or ibruprofen?
Naproxen
44
What is the potency of NSAIDs linked to?
Increase in adverse effects
45
What are the adverse effects of NSAIDs?
Renal - Prostanoid inhibitor - decreased renal blood flow, imbalance in vasodilation mechanism, ischemia and water/sodium retention Reduced platelet aggregation - aspirin is an antiplatelet. - inhibitoin of COX2 Reyes syndrome in children (aspirin) - encephalopathy Hypersensitivity and cross reactions GI side effects - inhibition of COX 1 - Gastric ulcers
46
Who should you take caution with prescribing NSAIDs in?
Asthmatics Heart failure Ascites
47
What drugs do NSAIDs interact with ?
Warfarin Methotrexate Lithium
48
What are the risk factors for GI side effects in NSAIDS
``` Age >65 Previous history of peptic ulcer Previous upper GI bleeding Dyspepsia Oral anticoagulant therapy Long term NSAIDs use for RA and OA Excessive alcohol consumption Corticosteroid treatment Treatment dose heparin and LMWH ```
49
If a patient has one or more risk factors for GI side effects while on NSAIDs what must you prescribe alongside the NSAID?
PPI
50
Give an example of a PPI and dose
Lansoprazole 15mg OD
51
What are weak opioids used for?
Moderate pain and anti - diarrhoal properties
52
What is the first line weak opioid?
Dihydrocodeine 30mg every 4-6hrs
53
What is codeine?
Pro-drug converted to morphine (CYP450-CYP2D6)
54
What is the problem with codeine in comparison to dihydrocodeine
Codeine metabolites are more likely to accumulate
55
Who must not be prescribe the full dose of codeine to?
Renal failure | Liver failure
56
What are strong opioids used for?
Severe or moderate acute pain
57
Name some strong opioids
Fentanyl Morphine Oxycodone
58
Which patients require lower doses of strong opioids?
Renal impairment Liver impairment Elderly
59
What is the strong opioid breakthrough dose?
1/6th - 1/10th the 24hr dose
60
How does potency vary amongst opioids
Differs on the type of opioid and route
61
If a strong opioid dose is ineffective how would you go about increasing the dose?
Increase by 30-50%
62
What IV morphine does oral morphine equal
Oral morphine = IV morphine x 2
63
What diamorphine sc does Oral morphine equal?
Oral morphine = SC diamorphine x 3
64
What oral oxycodone does oral morphine equal
Oral morphine = oral oxycodone x 2
65
What are the adverse effects of opioids?
Respiratory depression Constipation Nausea and vomiting Sedation Pruitius Tolerance
66
What must be prescribed alongside opioids
PRN Naloxone 100mcg IV/IM Stimulant laxative such as senna PRN antiemetics
67
What is nefopam?
``` Non opioid and non NSAID Affects serotonin, dopamine and noradranaline uptake and glutamate release 60mg TDS (30mg in elderly), titrated up to 90mg TDS as needed ```
68
What are the side effects of nefopam?
``` Nausea Dizziness Urinary retention Dry mouth Can turn urine pink ```
69
What is nefopam contraindicated in?
Convulsive disorders
70
Describe gabapentin
Neuropathic pain agent Acts on voltage gated calcium channels, blocking neuronal influx of calcium and decreasing glutamate release Opioid sparing so reduces side effects such as nausea and constipation
71
What trial of gabapentin is usually given?
300m STAT - effects seen within 30 mins if effective
72
Who requires a lower dose of gabapentin?
Renal impairment | Elderly

Clinical pharmacology and therapeutics (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions