Analgesics

Question 1

What are the signs and symptoms of opiate withdrawal? (4)

Answer 1

sweating,

abdominal cramps,

restlessness, anxiety.

Question 2

Which are the weak opiods? (2)

Answer 2

Co-codamol

Co-dydramol

(metabolised by P450 pathway to morphine)

Question 3

What are the side effects of opioids?

Answer 3

Constipation,

nausea (due to activation of CTZ - oftens settles with use), sedation, depression, sexual dysfunction - increased risk of erectile dysfunction, - n.b. this is reversal but can take a month,

Affects skin - histamine release causing itching, urticaria, vasodilation, sweating.

increase risk of falls.

Can cause hyperalgesia - increase sensitivity to pain.

Opioid dependence disorder - i.e. addition! Increased tolerance. Oxycodone can be addictive after only one month.

Increased risk of long-term sickness/ off work

Morphine and fentanyl have immunosuppressive properties.

Question 4

Cautions with prescribing opiates? (2)

Answer 4

Hx of Resp disease

Other sedating drugs (antipsychotics, benzodiazepines, tricyclic antidepressants)

Question 5

Overdose of paracetamol/ opioid - what’s the difference?

Answer 5

paracetamol - hepatotoxicity

opioids - neurological and respiratory depression

NB. Care with prescribing opioids with the elderly.

Question 6

MOA of strong opioids? and problem related to MOA?

Answer 6

Affects u receptors (opioid receptors) in the c.n.s.

Question 7

Codeine is metabolised to morphine in the liver, dihydrocodeine is metabolised to …..

Answer 7

dihydromorphine

Question 8

What is tramadol, and what’s its strength? And how is it different?

Answer 8

It’s a synthetic form of codeine,

Moderate strength

affects ‘u’ receptors, but also acts as a serotonin and noradrenaline reuptake inhibitor?

Question 9

Why do you need to be careful with tramadol and SSRIs?

Answer 9

Tramadol affects sertonergic and adrenergic pathways, it LOWERS the seizure threshold.