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Pain & Palliative Flashcards

1
Q

Which neurotransmitter is implicated in Migraine?

A

Calcitonin gene related peptide

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2
Q

Baclofen Activate?

A

GABA(b)

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3
Q

In normal resting condition Glutamate an excitatory neurotransmitter is inhibited by?

A

Magnesium

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4
Q

M/A of paracetamol includes?

A

1.central Cox inhibitor
2.Activate inhibitory Descending spinal pathway via serotonergic mechanism
3.Endocannaboid Reuptake inhibitor
4.Inhibits NO & TNF-alpha

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5
Q

M/A of TCA?

A

1.serotonin & NE reuptake inhibition at synapse in spinal cord
2.potential effect in Limbic system
3.reduce Na channel

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6
Q

M/A NSAID?

A

Inhibit Prostaglandin synthesis

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7
Q

M/A of opioids?

A

Opioid receptor agonist
& block ascending pain pathway

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8
Q

M/A ketamine?

A

1.NMDA antagonist
2.Reduction in central Pain sensitisation

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9
Q

M/A Capsaicin?

A

Activates TRPV-1 on subset of C fibre

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10
Q

M/A lidocaine?

A

Na channel blocker

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11
Q

Which opiod is safe at Renal impairment?

A

Buprenorphine

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12
Q

Fastest nerve fibre?

A

A alpha

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13
Q

Unmyelinated nerve fibre?

A

c fibre

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14
Q

What do you mean by allodynia?

A

Pain due to non painful stimuli like light touch

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15
Q

Negative sensory disturbances include?

A

Numbness
Tingiling(parasthesia)
Loss of temperature & sensitivity

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16
Q

What is formication?

A

Feeling of insect crawling over skin

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17
Q

1st line drugs for Neuropathic pain?

A

1.SNRI(Duloxetine)
2.TCA
3.Gabapentin and pregabalin

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18
Q

If 1st line drugs for neuropathic pain fails?

A

2nd line-

capsaicin patch,lidocaine patch,Tramadol…

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19
Q

Third line drugs for neuropathic pain?

A

Botulinum toxin,strong opioid

20
Q

Strong recommended drugs for Neuropathy?

A

1st line

21
Q

CRPS (complex regional pain syndrome) is diagnosed by?

A

BUDAPEST CRITERIA

Sensory,Motor,sudomotor,vasomotor

22
Q

Palliative Care

The commonest barrier to assessment of palliative pain is?

A

Idiosyncratic shortcuts

23
Q

Palliative Care

How you clinically assess pain in cancer patient?

A

EPAT(Edinburg Pain assessment and management Tool)

Simple screening question..In a scale of 0-10

24
Q

Palliative Care

What is the mainstay treatment in cancer associated pain?

A

Pharmacological treatment

25
Q

Palliative Care

Who analgesic ladder?

A

Step1- paracetamol/Nsaid
Step2-1+weak opioid
Step3-strong opioid

26
Q

Palliative Care

Most commonly prescribe strong opoid?

A

Morphine

27
Q

Palliative Care

Most effective and appropriate route for morphine?

A

Oral

28
Q

Palliative Care

Effective morphine equivalent dose for cancer pain?

A

200mg/day

29
Q

Palliative Care

Treatment of choice for pain due to bone metastasis?

A

Radiotherapy

30
Q

Palliative Care

Drug of choice for pain arising from liver capsule?

A

Glucocorticoid

31
Q

Palliative Care

Pain for raise ICP?

A

Glucocorticoid
Radiotherapy
Opioid

32
Q

Palliative Care

Ishchemic pain?

A

Nsaid & ketamine

33
Q

Palliative Care

Opioid related resistant constipation..Rx?

A

Opioid+Naloxone combinations

34
Q

Palliative Care

To break opioid related nausea cycle?

A

IV haloperidol/levomepromazine

35
Q

Palliative Care

In Opioid,which symptoms are beyond tolerance?

A

Dry mouth & constipation

36
Q

Palliative Care

Indications of glucocorticoids in palliative care?

A
  1. Raised ICP
    2.Liver capsule pain
    3.Nerve compression
    4.Soft tussue infiltration
37
Q

Palliative Care

Treatment of choice for severe resistant neuropathic pain

A

Ketamine(NMDA antagonist) under specialist supervision.

38
Q

Palliative Care

Following radiotherapy to releive pain in bone metastasis, pt develops transient flare of pain..Mx?

A

24-48 Hrs Dexamethasone

39
Q

Palliative Care

Management of palliatiave Breathlessness?

A

Opioid both oral and parental are effective…If anxious,lorazepum may be given..

O2 has no role

40
Q

Palliative Care

Persistent nonproductive cough in palliative care..treatment?

A

Opioid

41
Q

Palliative Care

Productive/troublesome secretion..Rx?

A

Hyosine hydrobromide..Commonest A/E dry mouth

42
Q

Palliative Care

In cancer patient which drug temporarily boost appetite?

A

Glucocorticoids

43
Q

Antiemetic

Drugs act on CTZ

A

D2 antagonists
Haloperidol and Metoclopromide

CTZ is stimulated by drugs and toxins or metabolites..So this drugs are indicated

44
Q

Antiemetic

Drugs act on vomiting center?

A

Anti H1,Ach

Cyclizine
Hyoscine
Levomepromazine

Motion sickness এ ভালো কাজ করে

45
Q

Antiemetic

Gut distension stimulate which receptor?

A

Via vagus Histamin receptor H1

46
Q

Antiemetic

Histamine receptor located in?

A

Vomiting centre and Gut

47
Q

Antiemetic

Gut chemoreceptor?

A

5-HT

As chemorceptor it stimulates CTZ

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