opioids Flashcards
important safety info MHRA: BZPNS (+like drugs) and OPIOIDS
- 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
If BZDPN (+like drug) is co prescribed with opioid, what should you do
closely monitor for signs of resp depression at initiation and when there is any changes in prescribing
If methadone is co prescribed with BZPN (/like drug) what should you be aware of
respiratory depressant effect of methadone may be delayed
monitor pt for at least 2 weeks after initiation of changes in prescribing
why are opioids contraindicated in head injury and raised intracranial pressure
they interfere with pupillary responses vital for neurological assessment
can opioids cause central sleep apnoea
yes dose dependent increased risk of central sleep apnoea
consider total opioid dose reduction
respiratory depression is a major concern with opioid analgesics. what can be used to treat it. and what can it be reversed by? (2)
artificial ventilation
or be reversed by naloxone
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
3 months
opioid overdose causes the following 3 symptoms
coma
resp depression
pinpoint pupils
specific antidote for opioid overdose
nalaxone
MOA buprenorphine
opioid receptor partial agonist
- has both agonist and antagonist properties
buprenorphine patches for pain - how many variations of ‘x’ day patches are there
7 day patches
4 day patches
3 day patches
name the 7 day buprenorphine patches
bunov, bupramyl, butec, butrans, panitax, rebrikel, reletrans, sevodyne
bunov, bupramyl, butec, butrans, panitax, rebrikel, reletrans, sevodyne - how many day patches?
7 day buprenorphine
name the 4 day patches buprenorphine
bupeaze
carlosafine
relevtec
transtec
name the 3 day patch for buprenorphine
hapoctasin
buprenorphine - can you administer other opioids after patch removal
no not within 24h of patch removal because long duration of action
pt has fever and is on buprenorphine patch
what do you advice
monitor for signs of increased SE if fever present as extra absorption is possible
effects of buprenorphine when naloxone is adminsitered
effects are only partially reversed
pre treatment screening of buprenorphine for opioid dependence
documentation of viral hepatitis status recommended
how to use transdermal 7 day buprenorphine patches
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
how to use transdermal 3,4 day patches of buprenorphine
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
are transdermal buprenorphine patches suitable for acute pain or in pt whose analgesic requirements are changing rapidly
no because the long time to steady state prevents rapid titration of dose
what should pt do if spontaneous expulsion of SC implant (Sixmo for opioid dependence) occurs
seek immediate medical advice
and store implant in closed glass jar away from others
A prescription comes in for a patient who is 13 for codeine 15mg tabs QDS prn. Can you dispense this?
Yes it can be used to relieve acute moderate pain in children 12-17 (if other pain killers cant relieve it)
What age can codeine be used in
12 onwards
max daily dose of codeine should not exceed …. in children aged 12-18 years
240mg
can codeine be used in BF
no
when is codeine contraindicated in children under 18
in all children under 18 who undergo removal of tonsils or adenoids for treatment of obstructive sleep apnoea
can codeine be used in children whose breathing may be compromised
not recommended
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
ask them if they have acute UC
if so codeine is contraindicated
codeine is contraindicated in known ultra rapid metabolisers. why?
marked increase in toxicity in pt who are ultra rapid metabolisers
diamorphine is also known as the following street drug
heroin
dipipanone is only available as a formulation with
cyclizine
why is dipipanone not recommended in palliative care
only form available has cyclizine
