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
Common Opioid Side Effects
Constipation
nausea
sedation
Dry mouth
Less Frequent Opioid Side Effects
Psychomimetic effect
Confusion
Myoclonus
Rare Opioid Side Effects
Allergy
Respiratory Depression
Pruritus
Fentanyl
for stable opioid responsive pain
Indications - intolerable side effects / oral route difficulties/ renal impairment
- take 12hrs to reach analgesic concentrations
