High risk drugs

Question 1

Main side effects of opioids ?

Answer 1

• hypogonadism and adrenal insufficiency
• hyperalgesia
• respiratory depression
• dependence

Question 2

To what Hypogonadism and adrenal insufficiency lead to ?

Answer 2

amenorrhea, reduced libido, infertility, depression or ED

Question 3

If patient develops hyperalgesia, what can be done ?

Answer 3

hyperalgesia: increased sensitivity to pain, in such cases a dose reduction or an alternative medicine should be considered.

Question 4

What is the max dose of codeine in children aged 12-18 years ?

Answer 4

the maximum daily dose should not exceed 240mg and only for 3 days

Question 5

Codeine is contraindicated in….?

Answer 5

-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
-

Question 6

What affects codeine has on pupils?

Answer 6

cause pin point pupils

Question 7

Name morphine 12-hourly preparations ?

Answer 7

MST continus, morphogesic SR, zomoprh

Question 8

What is the standard dose of a strong opioid for breakthrough pain ?

Answer 8

one tenth to one sixth of the regular 24 hour dose, which can be repeated 2-4 hourly as required

Question 9

Can buprenorphine be reversed fully or partially by naloxone and why ?

Answer 9

buprenoprhine is an opioid antagonist as well as an opioid agonist, partially reversed

Question 10

How long after buprenoprhine path other opioids can be administered ?

Answer 10

other opioids should not be administered within 24 hours of pacth removal due to long action of buprenoprhine

Question 11

Which buprenoprhine patches have 7 day formulation ?

Answer 11

butec, butrans, reletrans, sevodyne, panitaz

Question 12

Which buprenoprhine patches are 96 hourly ?

Answer 12

transtec, buplast, bupeaze, relevtec

Question 13

which buprenoprhine patches are 72 hourly application ?

Answer 13

hapoctasin, prenotrix

Question 14

How should opioid patches be applied ?

Answer 14

to dry, non-irritated, non-hairy on upper torso or upper outer arm.

Question 15

How should fentanyl buccal film must be used ?

Answer 15

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

Question 16

Name 12-hourly preparations of oxycodone ?

Answer 16

Abtard, Carexil, Iyldone, Leveraxo, Longtec,

Oxeltra, OxyContin, Oxypro, Oxylan, Reltebon and Renocontin.

Question 17

Name 24-hourly preparations of oxycodone ?

Answer 17

Onexila XL.

Question 18

If eGFR is less than 10 ml/min can oxycodone be prescribed ?

Answer 18

no avoid

Question 19

If patient has mild to moderate renal impairment what maximum initial dose of oxycodone can he be prescribed ?

Answer 19

2.5 mg every 6 hours in patients not currently treated with an opioid with mild to moderate impairment

Question 20

How long can it take till NSAIDs maximum effect of pain relief kicks in ?

Answer 20

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

Question 21

What are the interactions of NSAIDs?

Answer 21

active gastro-intestinal bleeding, ulceration, history of GI bleeding to previous NSAIDs, IHD, mild heart failure, severe HF or peripheral arterial disease

Question 22

Why should NSAIDs be particularly avoided in the third trimester of pregnancy ?

Answer 22

risk of fetal ductus ateriosus, persistent pulmonary hypertension, delayed/prolonged labour. Avoid during breastfeeding as well