Pain/MSK Flashcards
(29 cards)
NSAID
Name
Diclofenac
NSAID
Mechanism of action
Inhibits prostaglandin synthesis via COX and modulates arachidonic acid release/uptake
NSAID
Indications
Pain, RA, osteoarthrosis, LBP, migraines, MSK acute issues, AS, acute gout
NSAID
Contraindications
PUD/gastric pain, CHD, organ failure, last trimester
NSAID
Side effects
Vertigo, N&V, diarrhoea, dyspepsia, elevated AST, rash, fluid retention
NSAID
Interactions
Chemotherapy drugs, methotrexate, renal impairment, warfarin
NSAID
Prescription advice
Take with food, consider gastroprotection >60/PUD
Compound Opioids
Name
Cocodamol, co-dydramol
Cocodamol
Mechanism of action
Activated by CYP450 to morphine, agonises opioid mu-pain receptors
Cocodamol
Indications
Mild-moderate pain
Cocodamol
Contraindications
Respiratory disease, renal/hepatic impairment
Cocodamol
Side effects
Nausea, constipation, drowsiness, toxic (hepatotoxic pcm/neuro-resp from opioid)
Cocodamol
Interactions
Avoid with other sedatives (antipsychotic, benzos, TCAs)
Strong Opioids
Name
Morphine, Oxycodone
Morphine
Mechanism of Action
Activates mu-opioid receptors to relieve pain, reduces response to hypercapnia/hypoxia
Morphine
Indications
Acute severe pain, chronic pain, end of life breathlessness
Morphine
Contraindications
Resp failure, hepatic/renal impairment, biliary colic (sphincter of oddi spasm)/pancreatic issues
Morphine
Side effects
Resp depression, neuro depression, can activate CTZ, pupillary constriction, increased smooth muscle tone, urticarial
Morphine
Interactions
Other sedative meds
Non-opioid analgesic
Paracetamol
Mechanism of action
Weak COX inhibitor reduces fever due to hypothalamic interaction, otherwise poorly understood
Paracetamol
Indications
First line analgesic, anti-pyrexial
Paracetamol
Contraindications
Chronic ETOH XS (raised NAPQI), reduced glutathione stores (malnourished, underweight)
Paracetamol
Side effects
Hepatotoxic
Paracetamol
Interactions
CYP inducers increase risk of toxicity (phenytoin, carbamazepin)
