PSA Pain Management 3

Question 1

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

Accepted Answer

Paracetamol 1 g QDS

Answer

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

Question 2

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

Accepted Answer

Children under 12 years

Answer

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

Question 3

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

Accepted Answer

Omeprazole 20 mg OD

Answer

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

Question 4

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

Accepted Answer

Codeine

Answer

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

Question 5

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

Accepted Answer

NSAIDs are generally contraindicated; use colchicine with dose adjustment instead

Answer

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

(PSA) Prescribing Safety Assessment Practice Test

(PSA) Prescribing Safety Assessment Practice Test

PSA Pain Management 3