Analgesics Flashcards
Paracetamol
Analgesic and antipyretic
D- 500-1000mg (child 15mg/kg) q4-6h. Max 4000mg/d
AE- N/V
M- pain/fever resolution, LFT in chronic use
CAL- 13, 19a, A(MR)
Aspirin
Analgesic/ antiplatelet
D- 300-900mg q4-6h prn (max 4g daily) for analgesia or 75-150mg once daily for antiplatelet. Take with food
AE- bleeding, hypertension, reflux, NV
M- BP, renal function
Not safe P/BF or <16yo
CAL- 9 (low dose), 13, 19b (high dose), A (EC), B
Codeine
Analgesic, antidiarrhoeal, antitussive
D- pain/diarrhoea 30-60mg q4-6h prn (max 240mg in 24h). Cough 15-30mg tds-qid
AE- constipation, drowsiness (label 1), dry mouth, dizziness
M- tolerance and dependence, constipation, pain relief
Preg cat A- avoid close to term. Not recommended BF
Chronic use- stool softener/laxative, dental hygiene
CAL- 1
Fentanyl
Opioid analgesic
D- lozenge 200mcg initially, repeat once after 30min. Patch every 72 hours
AE- drowsiness, constipation, dry mouth
M- tolerance and dependency, CNS and respiratory depression, constipation, dental hygiene
CAL- 1, 5, 13 (lozenge, ODT, SL), 21
Morphine
Opioid analgesic
D- IR/IM/IV/SC 5-20mg q4h
CR 5-60mg q12h
AE- constipation, drowsiness, dizziness, NV, dry mouth
M- resp and CNS depression, dental hygiene, pain relief, tolerance and dependence
P/BF- avoid if possible, resp depression in infant
CAL- 1, A (CR)
Oxycodone
Opioid analgesic
D- IR 5-15mg q4-6h
CR 5-10mg q12h
Titrate dose- doses >400mg/d have been used
AE- constipation, drowsiness, dizziness, NV, dry mouth
M- resp and CNS depression, dental hygiene, pain relief, tolerance and dependence
P/BF- avoid if possible, resp depression in infant
CAL- 1, 18, A (CR)
Tapentadol
Opioid analgesic with NRI effects
D- 50-250mg bd (max 500mg/d)
AE- constipation, drowsiness, dizziness, NV, dry mouth
M- resp and CNS depression, dental hygiene, pain relief, tolerance and dependence
P/BF- not recommended little data, resp depression in infant
CAL- 1, 5, 16, A(CR)
Tramadol
Opioid analgesic with SNRI effects
D- IR 50-100mg q4-6h. Max 400mg/d
12h CR- 100-200mg q12h
24h CR- 100-400mg once daily
AE- constipation, drowsiness, dizziness, NV, dry mouth, sweating, headaches
M- resp and CNS depression, dental hygiene, pain relief, tolerance and dependence
P/BF- avoid if possible, resp depression in infant
CAL- 1, 5, A (CR)
Triptans
Antimigraine (serotonin agonist)
Dose
Eletriptan- 40-80mg at onset, repeat after 2hours (max 160mg/d, most say 80mg/d due to high rate AE)
Naratriptan- 2.5mg at onset repeat after 4 hours, max 5mg/d
Sumatriptan- 50-100mg at onset, repeat after 2 hours. Max 300mg/d
AE- drowsiness/ dizziness, hot/cold sensations, tingling, nausea
R- SOB or pain or tightness in chest
30-60min for effect
Take as headache develops, not during aura or once headache is severe
Do not take second dose if there is no improvement
CAL- eletriptan: 12, 13, A
Naratriptan/sumatriptan: 12
Buprenorphine
MOA- partial opioid agonist
I- moderate- severe pain, opioid replacement therapy
Dose:
SL 200-400microg q6-8h prn
IM/IV- 300-600microg q6-8h
Patch- 5-40microg/h patch changed weekly
AE- constipation, drowsiness, dizziness, NV, dry mouth, skin reactions from patch
M- resp and CNS depression (not readily reversed by naloxone), dental hygiene, pain relief, tolerance and dependence
C- rotate patch site, write date on patch, dry non-irritated hairless skin, avoid direct heat sources, check still in place, dont cut patches
CAL-1, 21 (patch), 13 (SL)
Pethidine
AKA meperidine
I- moderate- severe acute pain, Opioid adjunct during anaesthesia
P- serotonin toxicity, renal, hepatic, elderly
Dose- IV 5-20mg every 3-5min. IM/SC 20-125mg q2h. for young adults max 1000mg in first 24h, then 600mg daily for max 24-36h.
AE- constipation, drowsiness, dizziness, NV, dry mouth, seizures, aggitation, tremor, muscle twitching
M- resp and CNS depression, dental hygiene, pain relief, tolerance and dependence, seretonin toxicity
CAL- 1, 5
Not recommended- no advantage and multiple disadvantages over other opioids. Do not use naloxone for norpethidine (active metabolite) toxicity- antagonises sedative but not excitatory (seizures, tremor, agitation, twitching, anxiety) symptoms. Rarely appropriate.
Hydromorphone
Opioid analgesic (5-7x more potent than morphine) I-moderate-severe pain
P-renal and hepatic
Dose (for opioid naive)
IR 2-4mg q4h (titrate dose to give analgesia for 3-4hours then convert to CR)
SC/IM- 0.4-2.5mg q2h prn (lower doses with age)
IV- initially 0.1-0.4mg then titrate
AE- constipation, drowsiness (label 1), dizziness, NV, dry mouth
M- resp and CNS depression, dental hygiene, pain relief, tolerance and dependence
CAL- 1
Methadone
I- severe chronic pain, opioid replacement therapy
P- QT prolongation, Renal (longer interval), Hepatic, elderly
Dose: initially oral/IM/SC 5-10mg q6-8h (for chronic use give 12 hourly). For opioid replacement- usual maintenance 30-50mg max 80mg daily.
AE- constipation, drowsiness, dizziness, NV, dry mouth, QT prolongation
M- resp and CNS depression, dental hygiene, pain relief, tolerance and dependence
Not suitable for acute pain due to long half life, variable pharmacokinetics, difficult titration
CAL- 1
