Chapter 4 BNF (Pain)

Question 1

What’s best for MSK pain?

Answer 1

Non opioids

NSAIDs

Question 2

What’s best for dental pain?

Answer 2

NSAIDs

Find cause

Question 3

What can be offered for period pain?

Answer 3

Oral contraceptives
Antispasmodics
Non opioids

Question 4

What can be offered for nerve compression by a tumour?

Answer 4

Dexamethasone

Question 5

What dose aspirin should be given in medical emergencies?

Answer 5

Aspirin 300mg dispersinble or chewable. NOT Gastro resistant

Question 6

What’s the aspirin dose for pain?

Answer 6

300-900mg every 4-6 hours

Max 4G

Question 7

When can aspirin be used in under 16?

Answer 7

Kayaking disease as an antiplatelet

Question 8

What’s the dose of breakthrough pain

Answer 8

1 tenth to 1 sixth of the total daily dose every 2-4 hrs when required

Question 9

What can be given for opioid overdose?

Answer 9

Naloxone

Question 10

What are the side effects of opioid!

Answer 10

Dry mouth 
Nausea and vomiting 
Constipation 
Sedation 
Euphoria

Question 11

Which opioid side effects doesn’t improve with time?

Answer 11

Constipation

Question 12

What side effects can occur with larger doses of opioids?

Answer 12

Hypotension
Muscle rigidity
Pupil constriction

Question 13

What side effects can occur with long term use of opioid?

Answer 13

Hypogonadism
Adrenal insufficiency
HYPERALGESIA

Question 14

When should opioids NOT be given?

Answer 14

Comatose patients
Paralytic ileus
Asthma attack and COPD

Question 15

How often is standard release morphine given?

Answer 15

Every 4 hours

Question 16

How often is MR morphine given?

Answer 16

Every 12/24 hours

Question 17

What is the maximum dose increase increments for morphine ?

Answer 17

1/3 to 1/2 every 24hrs

Question 18

How must the morphine dose be adjusted going from oral to IV/IM/SC?

Answer 18

1/2

Question 19

How must the morphine dose be adjusted going from oral to IV/IM/SC diamorphine?

Answer 19

1/3

Question 20

What is the mechanism of action for buprenorphine?

Answer 20

Partial opioid agonist

Question 21

How does naloxone affect buprenorphine?

Answer 21

Partially

Question 22

How must buprenorphine be separated with other opioids?

Answer 22

24 hrs

Question 23

What’s the risk with opioid naive patients and fentanyl

Answer 23

Respiratory depression

Question 24

When should fentanyl patients be removed IMMEDIATELY?

Answer 24

Breathing difficulties
Confusion
Dizziness

Question 25

When must opioid dose be reduced 1/4 to 1/2 when switching to fentanyl?

Answer 25

Switching due to HYPERALGESIA

Question 26

When is fentanyl unsuitable?

Answer 26

Acute pain

Rapidly changing pain

Question 27

What advice should be given to patients with patches ?

Answer 27

Avoid exposure to external heat
Apply to dry/ non hairy skin

Rotate

Question 28

What’s the dose of codeine codeine in adults?

Answer 28

30-60mg every 4hrs

Question 29

What is the MHRA on codeine

Answer 29

Restricted use in children

Question 30

What’s the dose for codiene in 12-18 yrs?

Answer 30

Max 240 a day for 3 days

Question 31

Which opioids should not be given IV ?

Answer 31

Codeine

Dihydrocodiene

Question 32

What patients should not take codiene ?

Answer 32

U18 with tonsillectomy’s

Breastfeeding

Question 33

What are the additional effects of tramadol? What are the side effect implications?

Answer 33

Also affects serotonergic & noradrenergic pathways

Risk of bleeding
Lowers seizure threshold
Psychiatric reactions

Question 34

What are the benefits of tramadol?

Answer 34

Lower risk of respiratory depression

Question 35

What are the interactions with tramadol?

Answer 35

Seizure threshold
Serotonin syndrome
Risk of bleeding