Analgesia Flashcards
What are the main side effects of opiods?
Constipation
Respiratory depression
Reduced GCS
What are the main risks of NSAIDS?
Peptic Ulcer
AKI if fluid depleted
What is the equivalent oral morphine dose of 1mg of subcutaneous diamorphine?
3mg (approx 3x)
What is the equivalent subcutaneous morphine dose of 1mg of subcutaneous diamorphine?
1.5mg
What is the equivalent oral codeine dose of 1mg of subcutaneous diamorphine?
35mg
What is the equivalent oral tramadol dose of 1mg of subcutaneous diamorphine?
15mg
Describe the pain assessment tool most commonly used in Tayside?
Verbal rating scale using 0 -3:
0: No pain at rest or on movement
1: No pain at rest, slight on movement
2: Intermittent at rest, moderate on movement
3: Continuous at rest, severe on movement
What is step 1 of the WHO pain ladder?
Non opioid eg regular paracetamol
What is step 2 of the WHO pain ladder?
Opioid such as codeine + Non opioid
What is step 3 of the WHO pain ladder?
Opioid such as morphine + non opioid
What is correct way to initially treat most patients with acute pain?
Dilute morphine to a 1mg in 1ml solution and titrate in 1 -2mg increments to effect, observing for side effects.
What drug is used to counter the respiratory depression caused by opioids?
Naloxone
How is naloxone best given in opioid induced respiratory depression?
A bolus of 0.4mg -2mg +/- further bolus. It is best given in small increments and titrated to effect as this reverses the sedation and respiratory depression without reversing the analgesia.
What are the possible side effects of naloxone?
Hypertension
Arrhythmias
Pulmonary oedema
Cardiac arrest following IV bolus
What is the standard PCA (Patient controlled analgesia) prescription of morphine in the UK?
1mg morphine bolus, 5 minute lockout
