Analgesia Management Flashcards
Contra-indications of paracetamol
- moderate to sever liver failure
- kidney impairment
- weight below 50kg (max 500mg QDS)
Types of simple anaglesia
paractamol
NSAIDS- non-selevtive ibuprofen
- selective celecoxib
NSAID Contraindication
- Renal and platelet count
- GI bleeding or ulcer history
- asthma
- concurrent warfarin/ digoxin/ steroids
WHO Pain Ladder
- Simple analgesia
- Weak opioid
- Strong Opioid
Examples of Weak Opioids
Codeine
Dihydrocodeine
(Tramadol)
Weak Opioid Problems
ceiling effect- so if not effective replace with a strong opioid rather than add to.
Examples of Strong Opioids
Diamorphine - community Fentanyl - patch Morphine Buprenorphine - patch Oxycodone
Speciallist Palliative Care ONLY
Hydromorphone
Alfentanil
Methadone
Ketamine
Before Starting a strong opioid
- Previous experience
- Side Effects - prescribe laxatives
- Age/ Frailty/ Co-morbidities
- Renal Function
Codeine and tramadol are 1/10th as potent as oral morphine
60mg Codeine QDS = (ish) 24mg Morphine –>
Modified release
background pain
BD (12 hrs)
MST/ZOmorph
Oxytontin
Immediate Release
break through pain 30mins to take effect lasts 4-6hrs Oramorph/ Severdol Oxynorm
Oxycodone is twice as potent as morphine
30mg morphine –> 15mg oxycodone
Prescribing Opioids
- start low
- titrate dose according to pain and PRN usage
- stimulant laxatives (NOT BULKING)
- PRN antiemetic
PRN dose
1/6th of background dose
Background dose 30mg BD
- try 5-10mg
