CNS pain management Flashcards
PAIN MANAGEMENT
MILD?
NON-OPIATES: PARACETAMOL/NSAIDs/ASPIRIN
PAIN MANAGEMENT
MILD-MODERATE?
WEAK OPIATES: CODEINE/DIHYDROCODEINE
MODERATE: TRAMADOL (but lowers seizure threshold, serotonin syndrome, risk of bleed, psychiatric disorder)
PAIN MANAGEMENT
MODERATE-SEVERE?
ALL THE CDs!
STRONG OPIATES: MORPHINE/OXYCODONE/METHADONE/BUPRENORPHINE/FENTANYL
what is max dose for morphine dependent on?
pt individual factors- weight, tolerance etc
codeine used in pts over what age
12+
else respiratory SEs
co-codamol otc 12+ also!
linctus: 18+
codeine should be avoided in what 3 groups of pts?
U18 children who had tonsils remove due to sleep apnoea
patients who are ultra-rapid metaboliser (Afro-Caribbean) due to toxicity- quickly metab to morphine
Breastfeeding
why avoid codeine in u18 whove have tonsils removed due to sleep apnoea?
codeine can cause obstructive sleep apnoea, breathing problems while sleeping
OPIATES SIDE-EFFECTS?
Act on mu-pathway causing:
DRY MOUTH
CONSTIPATION
CNS DEPRESSION
N&V
HYPOTENSION
MIOSIS (pupil constriction)
STRONG OPIATES
PROLONGED USE SIDE-EFFECTS?
HYPOGANADISM- less hormone secretion
ADRENAL INSUFFICIENCY- heightened sensitivity to pain
HYPERALGESIA
what is hyperalgesia
body becomes dependent on it so smaller things that cause you pain, eg pinch, will be exacerbated and more drug needed to treat pain
symptoms of opioid OD
resp depression
unconscious/ coma
pinpoint pupils
STRONG OPIATES
OVERDOSE tx?
NALOXONE
STRONG OPIATES
AVOID IN…?
PARALYTIC ILEUS - reduce peristalsis of GIT causing constipation/ resp block
RESPIRATORY DISEASE
HEAD INJURY
STRONG OPIATES
BREAKTHROUGH PAIN dose?
1/6th- 1/10th of total daily dose,
every 2-4hours prn
max 12 times in a day. every 2 hrs
Patient on 120mg morphine, dose increase how much each day? for any opioid
Max. increase by 1/3 to 1/2 each day, i.e.
40-60mg increase
SWITCHING BETWEEN OPIATES- reduce dose of new opioid by hm TO PREVENT OD?
1/2 TO 1/3
OXYCODONE MORE POTENT THAN MORPHINE meaning more approp in which pts?
More appropriate in pt who cant consume large quantities due to nausea
PATCHES counselling points?
AVOID EXPOSURE TO HEAT
APPLY TO DRY HAIRLESS AREA
ROTATE SITE
FENTANYL PATCHES?
REMOVE PATCH IMMEDIATELY IF THERE ARE SIGNS OF TOXICITY
NEUROPATHIC PAIN
TCAs?
AMITRIPTYLINE/NORTRIPTYLINE
NEUROPATHIC PAIN
ANTIEPILEPTICS?
GABAPENTIN/PREGABALIN (1 week withdrawal regimen)
NEUROPATHIC PAIN
OPIATES?
MORPHINE/OXYCODONE/TRAMADOL
MOT
NEUROPATHIC PAIN
TOPICAL LOCALISED?
LIDOCAINE/
CAPSAICIN (intense burning sensation may limit use)
check nice cks and slides: counselling points
