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1

Week 230 - Pain: What are the short-term side effects of morphine?

• Nausea and Vomiting
• Constipation
• Addiction

2

Week 230 - Pain: What are the long-term side effects of morphine?

• Hormonal imbalance (leading to reduced testosterone, reduced libido, erectile dysfunction, gynaecomastia, fatigue)
• Opioid-induced hyperalgesia.
• Immune system dysfunction.

3

Week 230 - Pain: How do opioids reduce testosterone?

• Inhibit GnRH
• Low gonadotrophin secretion.
• Reduced gonadal androgen (Testosterone) secretion.

4

Week 230 - Pain: What is nociceptive pain?

• Pain caused by signals sent by nociceptive receptors in tissues.

5

Week 230 - Pain: What is neuropathic pain?

• Pain caused by damage to the nerves themselves.

6

Week 230 - Pain: What are the five levels of Loeser's model of pain?

1) Nociceptive
2) Attitudes and Beliefs
3) Suffering
4) Pain escape behaviour
5) Social environment

7

Week 230 - Pain: What is the chronic pain cycle?

1) Pain
2) Fear of movement
3) Avoidance or over-activity
4) Rest
5) Distress, Frustration, Worry
6) Physically De-conditioned
1) Pain

8

Week 230 - Pain: Give examples of the two main types of drugs used for analgesia.

• Non-opioid analgesics:
- Paracetamol, Ibuprofen, Naproxen

• Opioid analgesics:
- Codeine, dihydrocodeine, fentanyl, morphine, oxycodone, tramadol.

9

Week 230 - Pain: Which two drugs, indicated for other uses, are commonly used for the treatment of pain?

Gabapentin and amitrityline.

10

Week 230 - Pain: What are the three steps of the WHO analgesia ladder?

1) Non-opioid analgesic. +/- adjuvants.
2) Weak opioid and non-opioid. +/- adjuvants.
3) Strong opioid and non-opioid. +/- adjuvants.

11

Week 230 - Pain: What are the adjuvants that may be added to analgesia treatment for pain?

• Bisphosphonates.
• Steroids.
• Muscle relaxants.
• Antidepressants.

12

Week 230 - Pain: Which opioids are classed as 'weak'?

Codeine and dihydrocodeine.

13

Week 230 - Pain: Which opioids are classed as 'strong'?

Morphine, fentanyl, oxycodone.

14

Week 230 - Pain: What is the mechanism of action of paracetamol?

• Reduces central prostaglandin synthesis.

15

Week 230 - Pain: How do NSAIDS work?

They are competitive inhibitors of COX.
- COX2 - Reduces prostaglandin secretion and therefore inflammation.
- COX1 - GI damage, Renal damage leading to sodium and water retention, Worsens asthma.

16

Week 230 - Pain: If a patient has any GI risk factors what should you add when prescribing NSAIDS?

PPI

17

Week 230 - Pain: What are the beneficial effects of opioids?

Analgesia, Euphoria, Sedation, Cough Suppression, Anti-diarrhoeal activity.

18

Week 230 - Pain: Tramadol also has non-opioid effects, what are they?

• Inhibits the re-uptake of norepinephrine (noradrenaline) and stimulates serotonin release.

19

Week 230 - Pain: What cautions should be taken when prescribing tramadol?

• Caution taken in patients with risk of seizures, increased risk of CNS toxicities if given with anti-depressants.

20

Week 230 - Pain: What are the side-effects of opioids?

Common - Nausea and vomiting, Drowsiness, Unsteadiness, Delirium
Occasional - Sweating, Dry mouth, Hallucinations, Pruritus,

21

Week 230 - Pain: What is the first-line strong opioid analgesic?

Morphine

22

Week 230 - Pain: Which drug is used to reduce muscle spasm which may be causing pain?

Baclofen

23

Week 230 - Pain: What is gabapentin?

GABA analogue, reduces neuronal excitability.

24

Week 230 - Pain: What are the side-effects of gabapentin?

• Drowsiness, confusion, dizziness.

25

Week 230 - Pain: What are the side-effects of Amitriptyline?

• Drowsiness, arrhythmias, dry mouth, blurred vision.

26

Week 230 - Pain: Give examples of some of the local anaesthetics that can be used in the treatment of pain?

• Lidocaine patch
• Emla cream (Lidocaine, prilocaine)
• Nerve blocks.

27

Week 230 - Pain: What is the impact of Congenital Insensitivity to Pain (CIP)?

• Need to 'learn' to avoid dangerous behaviour.
• Musculoskeletal problems.
• Shorter life span.

28

Week 230 - Pain: What is the TRPV1 receptor?

• Capsaicin receptor.
• Pain receptor that reacts to thermal changes.
• It is activated by temperature above 43º.

29

Week 230 - Pain: Give examples of chemicals that cause sensitization of nociceptors and in turn produce the sensation of pain.

• Histamine
• Prostaglandins.
• Bradykinin.
• Substance P.

30

Week 230 - Pain: What are the two types of nociceptors?

• A∂ fibres.
• C-fibres.