Flashcards in Week 230 - Pain Deck (49)
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Week 230 - Pain: What are the short-term side effects of morphine?
• Nausea and Vomiting
• Constipation
• Addiction
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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
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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.
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Week 230 - Pain: Which two drugs, indicated for other uses, are commonly used for the treatment of pain?
Gabapentin and amitrityline.
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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.
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Week 230 - Pain: What are the adjuvants that may be added to analgesia treatment for pain?
• Bisphosphonates.
• Steroids.
• Muscle relaxants.
• Antidepressants.
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Week 230 - Pain: Which opioids are classed as 'weak'?
Codeine and dihydrocodeine.
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Week 230 - Pain: Which opioids are classed as 'strong'?
Morphine, fentanyl, oxycodone.
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Week 230 - Pain: What is the mechanism of action of paracetamol?
• Reduces central prostaglandin synthesis.
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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.
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Week 230 - Pain: If a patient has any GI risk factors what should you add when prescribing NSAIDS?
PPI
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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.
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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.
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Week 230 - Pain: What are the side-effects of opioids?
Common - Nausea and vomiting, Drowsiness, Unsteadiness, Delirium
Occasional - Sweating, Dry mouth, Hallucinations, Pruritus,
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Week 230 - Pain: What is the first-line strong opioid analgesic?
Morphine
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Week 230 - Pain: Which drug is used to reduce muscle spasm which may be causing pain?
Baclofen
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Week 230 - Pain: What is gabapentin?
GABA analogue, reduces neuronal excitability.
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Week 230 - Pain: What are the side-effects of gabapentin?
• Drowsiness, confusion, dizziness.
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Week 230 - Pain: What are the side-effects of Amitriptyline?
• Drowsiness, arrhythmias, dry mouth, blurred vision.
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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.
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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.
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Week 230 - Pain: What is the TRPV1 receptor?
• Capsaicin receptor.
• Pain receptor that reacts to thermal changes.
• It is activated by temperature above 43º.
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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.
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