15508318
Description
Flashcards by Amelia Claire, updated more than 1 year ago
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Created by Amelia Claire
over 5 years ago
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| Question | Answer |
| What do the guidelines recommend when you are starting an opioid-naïve patient on opioids? Non Pharma | Before starting a trial of opioid therapy, agree on realistic treatment goals with the patient (for example, walk to the shops, improved sleep along with an evaluation timeframe. The recommended duration of an opioid trial ranges from 2–6 weeks, to several months Encourage patients to have realistic expectations of treatment — for example, complete pain relief is unlikely, but some improvement in function and increased activity is expected |
| What do the guidelines recommend when you are starting an opioid-naïve patient on opioids? pharma | Choose a dose at the lower end of the range for opioid-naïve or elderly patients. Guidelines recommend starting with a low dose (for example, modified-release morphine 5–20 mg twice daily, or modified-release oxycodone 5–10 mg twice daily) and titrating slowly. |
| What is the role of codeine and codeine containing products in the treatment of chronic pain? | Codeine and codeine containing products have a limited role in the treatment of chronic pain. Codeine is a short-acting opioid suitable only for mild to moderate pain |
| When are patches unsuitable in the treatment of chronic pain? Why is this? | Patches are unsuitable for acute pain and fluctuating analgesic needs because they have a slow onset of action and long duration of effect. After initial patch application, it may take a few days for serum opioid concentrations to reach a steady state. |
| What role do paracetamol, aspirin, NSAIDs and opioids play in pain relief in pregnancy and breastfeeding? | paracetamol: safe aspirin: safe NSAIDs: linked to miscarriage, and not to be used after 30 weeks opioids: may be used but concerns about dependence At MotherSafe we reassure women regarding inadvertent NSAID use, but recommend paracetamol as first-line treatment of fever and pain during pregnancy. Codeine or another opioid analgesic can be added to treat more severe pain. NSAID use is contraindicated in the third trimester and alternative analgesics should also be considered in the first trimester. Women and their doctors should however be reassured that there are safe options to treat pain, both acute and chronic, during pregnancy and breastfeeding. |
| What are the various analgesics used in the treatment of chronic non-malignant pain? | paracetamol NSAIDs Opioids (limited role) tramadol (limited role) |
| Which of the analgesics identified as used in chronic non malignant pain should be used as first option? | paracetamol |
| What is the role of tramadol in treating chronic non-malignant pain? | Tramadol has a limited role in chronic pain management. It has limited analgesic activity, and a number of adverse effects and drug interactions, particularly with the serotonergic drugs that may be beneficial in chronic pain management. |
| What classes of drugs are used as analgesic adjuvants? When are they indicated in the treatment of chronic pain? | Analgesic adjuvants such as tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors, and antiepileptic drugs are sometimes used to treat chronic pain. Many patients with unexplained pain conditions may have a neuropathic component to their pain. In these patients a trial of adjuvant medications is indicated to assess the response. |
| What are the first, second and third choice analgesic adjuvants for the treatment of neuropathic pain? (Exact doses are not required) | amitriptyline gabapentin and pregablin duloxetine |
| What is the role of tramadol in treating chronic neuropathic pain? | Tramadol, classified as a weak opioid, also has serotonergic and noradrenergic effects and is therefore worth considering before a trial of a strong opioid. Tramadol should be used with caution with TCAs because of the risk of seizures. |
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