Analgesics Flashcards
Name 2 classes of pain relief
- Non-opioid analgesics
- Opioid analgesics
Name 2 classes of non-opioid analgesics
- NSAIDs
- Paracetamol
Name the 2 classes of NSAIDs
- Nonselective NSAIDs (COX-1 and COX-2 inhibitors)
- Selective NSAIDs (COX-2 inhibitors)
Name 9 nonselective NSAIDs (COX-1 inhibitors)
- Aspirin
- Diclofenac
- Ibuprofen
- Indometacin
- Ketoprofen
- ketOROLAC
- Mefenamic acid
- Naproxen
- Piroxicam
Name 4 selective NSAIDs (COX-2 inhibitors)
- Celecoxib
- Etoricoxib
- Meloxicam
- Parecoxib
Name 15 opioid analgesics
- buprenorphine
- codeine
- aspirin with codeine
- ibuprofen with codeine
- paracetamol with codeine
- fentanyl
- hydromorphone
- methADONe
- morphine
- oxycodone
- oxycodone with naloxone
- pethidine
- tAPENTadol
- tRAMadol
- tRAMadol with paracetamol
List the NSAIDs in order from most COX-1 selectivity to most COX-2 selectivity.
- Ketoprofen (Most COX-1 Selective)
- Aspirin
- Indometacin
- Ibuprofen
- Naproxen
- Piroxicam
- ketOROLAC
- Mefenamic acid
- Diclofenac (Most COX-2 Selective)
Name 12 opioid analgesics
- Alfentanil
- Buprenorphine
- Codeine
- Fentanyl
- Hydromorphone
- Methadone
- Morphine
- Oxycodone ± Naloxone
- Pethidine
- Remifentanil
- Tapentadol
- Tramadol
What is the opioid of choice in surgery?
Morphine
Why is morphine the opioid of choice for surgery?
As it has the best retention in the cerebrospinal fluid.
What must you always consider (besides age) when determining the dose when initiating an opioid?
Renal function
Why must you consider renal function when initiating an opioid?
As renally-cleared opioids will accumulate in poor renal function.
What should you consider if you see oxycodone and tramadol concurrently charted?
Check if there has been APS involvement.
What is the common approach to pain management by the Acute Pain Service?
They will commonly start a patient on paracetamol and oxycodone, then add tramadol if pain is still not sufficiently controlled
What is the rationale for the Acute Pain Service adding tramadol to a patient already on Oxycodone?
Tramadol has a slightly different mechanism to oxycodone.
What should you do if you see IV opioids charted on the ward?
Chase this with the team to have it removed (IV opioids can’t be given on the wards) and check to see if anything else should be charted in its place.
What is generally a requirement for a patient to be charted opioids as an inpatient?
They must be on regular paracetamol.
How must Targin be ordered by a ward?
A ward can send a distribution form for Targin but they must specify the patient details as they must have past history for pharmacy to be able to supply it.
Name 13 NSAIDs
- Aspirin (analgesic)
- Diclofenac
- Ibuprofen
- Indometacin
- Ketoprofen
- KetOROLAC
- Mefenamic acid
- Naproxen
- Piroxicam
- Celecoxib
- Etoricoxib
- Meloxicam
- Parecoxib
Name 9 Nonselective NSAIDs (COX‑1 and COX‑2 inhibitors)
- Aspirin (analgesic)
- Diclofenac
- Ibuprofen
- Indometacin
- Ketoprofen
- Ketorolac
- Mefenamic acid
- Naproxen
- Piroxicam
Name 4 Selective NSAIDs (COX‑2 inhibitors)
- Celecoxib
- Etoricoxib
- Meloxicam
- Parecoxib
Which NSAID tends to be most effective for headaches?
Aspirin
What is a practical benefit of aspirin over other NSAIDs in the setting of headache?
It tends to work faster.
What is an effective method of using aspirin to treat a sore throat?
Gargling soluble aspirin solution (even without swallowing)
What is ketOROLAC?
ketOROLAC is an intramuscular NSAID.
What is a risk of ketOROLAC?
People commonly go into renal dysfunction if it is overused.
What is an alternative to intramuscular dosing of ketOROLAC?
It can be given intravenously over 15 minutes (injection not infusion).
Describe the role of parecoxib
Parecoxib is often used intra-operatively
How should parecoxib be used in relation to other NSAIDs?
No other NSAIDs should be used 12 hours either said of parecoxib.
What is the indication of paracetamol modified release caplets 665mg as per Medication Profiler?
For the treatment of mild to moderate pain
What does the “other important information” section on MedProfiler say about paracetamol modified release caplets 665mg?
There are many brands of paracetamol. Do not exceed a total daily dose of 4 grams of paracetamol. Do not take more than 6 Panadol Osteo tablets per day.
What does the “generic subheading” section on MedProfiler say about paracetamol modified release caplets 665mg?
Swallow whole and do not crush or chew
