High risk drugs Flashcards
Main side effects of opioids ?
- hypogonadism and adrenal insufficiency
- hyperalgesia
- respiratory depression
- dependence
To what Hypogonadism and adrenal insufficiency lead to ?
amenorrhea, reduced libido, infertility, depression or ED
If patient develops hyperalgesia, what can be done ?
hyperalgesia: increased sensitivity to pain, in such cases a dose reduction or an alternative medicine should be considered.
What is the max dose of codeine in children aged 12-18 years ?
the maximum daily dose should not exceed 240mg and only for 3 days
Codeine is contraindicated in….?
-all children under 18 years, who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea, as life threatening adverse reactions have been reported.
-ultra rapid metabolisers of codeine
-
What affects codeine has on pupils?
cause pin point pupils
Name morphine 12-hourly preparations ?
MST continus, morphogesic SR, zomoprh
What is the standard dose of a strong opioid for breakthrough pain ?
one tenth to one sixth of the regular 24 hour dose, which can be repeated 2-4 hourly as required
Can buprenorphine be reversed fully or partially by naloxone and why ?
buprenoprhine is an opioid antagonist as well as an opioid agonist, partially reversed
How long after buprenoprhine path other opioids can be administered ?
other opioids should not be administered within 24 hours of pacth removal due to long action of buprenoprhine
Which buprenoprhine patches have 7 day formulation ?
butec, butrans, reletrans, sevodyne, panitaz
Which buprenoprhine patches are 96 hourly ?
transtec, buplast, bupeaze, relevtec
which buprenoprhine patches are 72 hourly application ?
hapoctasin, prenotrix
How should opioid patches be applied ?
to dry, non-irritated, non-hairy on upper torso or upper outer arm.
How should fentanyl buccal film must be used ?
moisten mouth, place film on inner lining of cheek, hold for at least 5 second until sticks, leave to dissolve ( 15-30 min ). If more than one film required do not overlap, use another area of mouth. Avoid liquids for five minutes after application,, avoid food until film is dissolved
Name 12-hourly preparations of oxycodone ?
Abtard, Carexil, Iyldone, Leveraxo, Longtec,
Oxeltra, OxyContin, Oxypro, Oxylan, Reltebon and Renocontin.
Name 24-hourly preparations of oxycodone ?
Onexila XL.
If eGFR is less than 10 ml/min can oxycodone be prescribed ?
no avoid
If patient has mild to moderate renal impairment what maximum initial dose of oxycodone can he be prescribed ?
2.5 mg every 6 hours in patients not currently treated with an opioid with mild to moderate impairment
How long can it take till NSAIDs maximum effect of pain relief kicks in ?
provide pain relief as soon as they are taken, however maximum effect can take up to 1 week. Anti-inflammatory effects can take up to three weeks. No response within these timeframes, then alternative NSAID should be considered
What are the interactions of NSAIDs?
active gastro-intestinal bleeding, ulceration, history of GI bleeding to previous NSAIDs, IHD, mild heart failure, severe HF or peripheral arterial disease
Why should NSAIDs be particularly avoided in the third trimester of pregnancy ?
risk of fetal ductus ateriosus, persistent pulmonary hypertension, delayed/prolonged labour. Avoid during breastfeeding as well
