Opioid management

Question 1

Co-codamol 30/500 8 in a day
ibuprofen 400mg tds

still pain how do you proceed

Answer 1

Total codeine daily dose is 240mg
this equals 24mg oral morphine (divide by 10)

when changing opiates consider reducing by up to 30% and retitrating

In this case reduce by 25% so 18mg morphine in a dat

MST continus or Zomorph 10mg bd

Question 2

Patient experiences unsteadiness on feet, constant yawning and nodding off, tremor and sweats, what do you do?

Answer 2

1. opioid toxicity
2. reduces morphine dose
3. ensure laxative taken alongside

Question 3

Advice for as required prescriptions

Answer 3

1. advice sought if over 6 doses in 24 hours

Question 4

Advice for SC

Answer 4

Volume maximum of 2ml

Question 5

Options for constipation treatment. palliative care guidelines

Answer 5

A - stimulant plus or softener
senna 15mg-30mg nocte, bisacodyl 5-10mg nocte

B- osmotic
laxido 1-3 sachets daily

C rectal treatment

soft loading - bisacodyl phosphate enema
hard loading - glycerol - stimulant then treat as above

Question 6

Just in case medicines requiring quantities in words and figures

Answer 6

Morphine
Diamorphine
Midazolam