opioids

Question 1

important safety info MHRA: BZPNS (+like drugs) and OPIOIDS

Answer 1

• risk of potentially fatal resp depression if co-prescribed
• additive CNS depressant effects so increased risk sedation, resp depression, coma, death
• only co-prescribe if no alt & ensure lowest possible dose for lowest duration

Question 2

If BZDPN (+like drug) is co prescribed with opioid, what should you do

Answer 2

closely monitor for signs of resp depression at initiation and when there is any changes in prescribing

Question 3

If methadone is co prescribed with BZPN (/like drug) what should you be aware of

Answer 3

respiratory depressant effect of methadone may be delayed
monitor pt for at least 2 weeks after initiation of changes in prescribing

Question 4

why are opioids contraindicated in head injury and raised intracranial pressure

Answer 4

they interfere with pupillary responses vital for neurological assessment

Question 5

can opioids cause central sleep apnoea

Answer 5

yes dose dependent increased risk of central sleep apnoea
consider total opioid dose reduction

Question 6

respiratory depression is a major concern with opioid analgesics. what can be used to treat it. and what can it be reversed by? (2)

Answer 6

artificial ventilation
or be reversed by naloxone

Question 7

long term use of opioids in non malignant pain (longer than … months) carries an increased risk of dependence and addiction, even at therapeutic doses. at the end of treatment, taper dose slowly to reduce risk of withdrawal effects

Answer 7

3 months

Question 8

opioid overdose causes the following 3 symptoms

Answer 8

coma
resp depression
pinpoint pupils

Question 9

specific antidote for opioid overdose

Answer 9

nalaxone

Question 10

MOA buprenorphine

Answer 10

opioid receptor partial agonist
- has both agonist and antagonist properties

Question 11

buprenorphine patches for pain - how many variations of ‘x’ day patches are there

Answer 11

7 day patches
4 day patches
3 day patches

Question 12

name the 7 day buprenorphine patches

Answer 12

bunov, bupramyl, butec, butrans, panitax, rebrikel, reletrans, sevodyne

Question 13

bunov, bupramyl, butec, butrans, panitax, rebrikel, reletrans, sevodyne - how many day patches?

Answer 13

7 day buprenorphine

Question 14

name the 4 day patches buprenorphine

Answer 14

bupeaze
carlosafine
relevtec
transtec

Question 15

name the 3 day patch for buprenorphine

Answer 15

hapoctasin

Question 16

buprenorphine - can you administer other opioids after patch removal

Answer 16

no not within 24h of patch removal because long duration of action

Question 17

pt has fever and is on buprenorphine patch
what do you advice

Answer 17

monitor for signs of increased SE if fever present as extra absorption is possible

Question 18

effects of buprenorphine when naloxone is adminsitered

Answer 18

effects are only partially reversed

Question 19

pre treatment screening of buprenorphine for opioid dependence

Answer 19

documentation of viral hepatitis status recommended

Question 20

how to use transdermal 7 day buprenorphine patches

Answer 20

apply 7 day patches to dry non irritated non hairy skin on upper torso or upper arm
site replacement patch on diff area
avoid applying to same area for 3 weeks

Question 21

how to use transdermal 3,4 day patches of buprenorphine

Answer 21

apply 3,4 day patches to dry non irritated non hairy skin on upper torso or upper arm
site replacement patch on diff area
avoid applying to same area for 7 days

Question 22

are transdermal buprenorphine patches suitable for acute pain or in pt whose analgesic requirements are changing rapidly

Answer 22

no because the long time to steady state prevents rapid titration of dose

Question 23

what should pt do if spontaneous expulsion of SC implant (Sixmo for opioid dependence) occurs

Answer 23

seek immediate medical advice
and store implant in closed glass jar away from others

Question 24

A prescription comes in for a patient who is 13 for codeine 15mg tabs QDS prn. Can you dispense this?

Answer 24

Yes it can be used to relieve acute moderate pain in children 12-17 (if other pain killers cant relieve it)

Question 25

What age can codeine be used in

Answer 25

12 onwards

Question 26

max daily dose of codeine should not exceed …. in children aged 12-18 years

Answer 26

240mg

Question 27

can codeine be used in BF

Answer 27

no

Question 28

when is codeine contraindicated in children under 18

Answer 28

in all children under 18 who undergo removal of tonsils or adenoids for treatment of obstructive sleep apnoea

Question 29

can codeine be used in children whose breathing may be compromised

Answer 29

not recommended

Question 30

a patient comes in asking for co codamol OTC for pain. You look at their PMR and see they are on octasa 800mg GR tabs. what do you do

Answer 30

ask them if they have acute UC
if so codeine is contraindicated

Question 31

codeine is contraindicated in known ultra rapid metabolisers. why?

Answer 31

marked increase in toxicity in pt who are ultra rapid metabolisers

Question 32

diamorphine is also known as the following street drug

Answer 32

heroin

Question 33

dipipanone is only available as a formulation with

Answer 33

cyclizine

Question 34

why is dipipanone not recommended in palliative care

Answer 34

only form available has cyclizine