Practice Test Geeks(PSA) Prescribing Safety Assessment Practice Test
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Pain Management Flashcards

7 cards from real PSA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A patient with a known peptic ulcer requires analgesia for mild-to-moderate pain. Which is the safest choice?

    Answer: Paracetamol 1 g QDS

    Paracetamol does not inhibit prostaglandin synthesis in the gastric mucosa and is safe in peptic ulcer disease, unlike NSAIDs.

  2. In which patient group is codeine absolutely contraindicated due to risk of life-threatening respiratory depression?

    Answer: Children under 12 years

    Codeine is contraindicated in children under 12 because ultra-rapid CYP2D6 metabolizers convert it to morphine at toxic rates, causing fatal respiratory depression.

  3. A 68-year-old with osteoarthritis is prescribed ibuprofen 400 mg TDS. Which co-prescription is most appropriate?

    Answer: Omeprazole 20 mg OD

    A proton pump inhibitor should be co-prescribed with NSAIDs in at-risk patients (age ≥65) to prevent NSAID-induced gastropathy.

  4. Which opioid is a prodrug requiring CYP2D6 metabolism for analgesic effect, making it ineffective in poor metabolizers?

    Answer: Codeine

    Codeine must be converted to morphine by CYP2D6; poor metabolizers (7–10% of the population) receive no analgesia from codeine.

  5. A patient has an eGFR of 12 ml/min and requires pain relief for acute gout. What is the most appropriate approach?

    Answer: NSAIDs are generally contraindicated; use colchicine with dose adjustment instead

    NSAIDs are contraindicated in severe renal impairment as they reduce renal perfusion further; dose-adjusted colchicine is preferred for acute gout.

  6. What is the first-line pharmacological treatment for peripheral neuropathic pain according to NICE guidelines?

    Answer: Amitriptyline, duloxetine, gabapentin, or pregabalin

    NICE recommends amitriptyline, duloxetine, gabapentin, or pregabalin as first-line options for neuropathic pain.

  7. When performing opioid rotation, why is the equianalgesic dose reduced by 25–50%?

    Answer: To prevent overdose due to incomplete cross-tolerance between opioids

    Incomplete cross-tolerance means patients are relatively opioid-naive to the new drug, so a full equianalgesic dose risks overdose.