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Opioids Quiz
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In the traditional three-step WHO analgesic ladder for cancer pain, which medicine is a Step 2 weak opioid used for moderate pain?
- A Tapentadol You picked ✕
- B Hydromorphone You picked ✕
- C Naproxen You picked ✕
- D Codeine You picked ✓
- E Amitriptyline You picked ✕
Correct!
Incorrect
The answer is D: Codeine
Explanation
Why D is correct
See The WHO Analgesic Ladder. Option D is correct. The WHO analgesic ladder was devised for cancer pain but is widely used as a framework for choosing the strength of pain relief. Step 1 is for mild pain and uses a non-opioid (paracetamol, with or without an NSAID). Step 2 is for moderate pain and uses a weak opioid such as codeine, dihydrocodeine or tramadol, with a non-opioid, with or without an adjuvant. Step 3 is for severe pain and uses a strong opioid such as morphine, oxycodone or fentanyl, again with a non-opioid. Adjuvants (drugs that help with pain from a specific cause, such as amitriptyline or gabapentin for nerve pain, or corticosteroids) can be added at any step. If pain is not controlled, you climb up the ladder, and a laxative should always be prescribed with regular strong opioids. Modern practice in cancer pain often skips Step 2 and goes straight to a low-dose strong opioid. A memory aid is one, two, three: non-opioid, weak opioid, strong opioid.
- Step 1: Mild pain, a non-opioid such as paracetamol.
- Step 2: Moderate pain, a weak opioid such as codeine, dihydrocodeine or tramadol.
- Step 3: Severe pain, a strong opioid such as morphine, oxycodone or fentanyl.
Sorting the list into non-opioid, weak opioid, strong opioid and adjuvant answers the question.
Why the other options are incorrect
- A. Tapentadol: Tapentadol is a strong opioid used at Step 3 for more severe pain, not the Step 2 weak opioid for moderate cancer pain. Your answer
- B. Hydromorphone: Hydromorphone is a strong opioid and belongs to Step 3 of the ladder, so it is used for severe pain rather than as the Step 2 weak opioid for moderate pain. Your answer
- C. Naproxen: Naproxen is a non-steroidal anti-inflammatory drug, which is used as a Step 1 non-opioid for mild pain rather than as the Step 2 weak opioid for moderate cancer pain. Your answer
- E. Amitriptyline: Amitriptyline is an adjuvant analgesic, often used for neuropathic pain, and can be added at any step. It does not define Step 2, which is for weak opioids. Your answer
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