opioids 2 Flashcards
can you use fentanyl in opioid naive patients
NO - MHRA ADVICE!
contraindicated in opioid naive pt. other anagesics and other opioids for non malignant pain need to be used first. there is considerable risk of respiratory depression with the use of fentanyl, especially in opioid-naïve patients, and significant risk with too rapid an escalation of dose, even in long-term opioid-tolerant patients.
are fentanyl patches suitable for acute pain or in pt whose analgesic requirements are changing rapidly
no because long time to steady state prevents rapid titration of dose
why should you give repeated intra op doses of fentanyl with care
resulting resp depression can persist postop and occasionally it may become apparent for the first time postop when monitoring of the pt might be less intensive
true or false - muscle rigidity can occur with IV admin of fentanyl
true
IV admin of fentanyl may cause muscle rigidity, which may involve the thoracic (chest) muscles. how can you avoid this
manufacturer advises admin by slow IV injection to avoid
higher doses may require premed with BZDPN and muscle relaxants
patient who is on fenttanyl patches says they are unwell. what should you do
if fever is present, monitor them for increased SE as increased absorption is possible
how many days are fentanyl patches
3 days (72h)
directions for administration of fentanyl patches
apply to dry non irritated non irradiated non hairy skin on torso or upper arm
remove after 72h and site replacement patch on diff area
avoid using same area for several days
when should pt immediately remove fentanyl patches
breathing difficulties
marked drowsiness
confusion
dizziness
impaired speech
seek prompt medical attention
indication for hydromorphine
severe pain in cancer
morphine is used in these 2 unlicensed indications for palliative care
treatment of cough and breathlessness at rest in palliative care
Name the 24h MR prep of morphine
MXL
MHRA - tapentadol (hint sero- and seiz-)
risk of seizures and reports of serotonin syndrome when given with other drugs
can induce seizures; caution in epilepsy or seizure disorders
what is the side effect of tapendatol being taken with SSRIs, SNRIs or TCAs, antipsychotics
these drugs lower seizure risk
so increased risk of seizure
also serotonin syndrome
side effects of prolonged use of strong opiates (e.g. morphine, diamorphine, methadone etc)
- 3 SE
hypogonadism (sex glands produce little to no sex hormones)
adrenal insufficiency
hyperalgesia (aka smaller sensations are more painful = high er dose needed)
dose to give for break through pain
1/6 to 1/10 of total daily dose every 2-4 hours prn
how much can you increase dose of an opiate by each day
1/2 to 1/3
WHO pain ladder - what section does tramadol go into
mild to moderate
codeine, dihydrocodeine, tramadol (FOR MODERDATE)
Which opioids are safe alt to morphine in RI
For pt with RI, lower dose or less frequent administration of morphine - or different opioid. e.g. An alt is oxycodone, or diamorphine if pt emaciated.
What are the safest opioids in RI
Fentanyl, alfentanil and buprenorphine are the safest opioids for use in RI.
what is breakthrough pain for opioids and how often
Breakthrough pain: 1/6th to 1/10th of total daily dose every 2-4 hours prn
How much can you increase dose of opiate by daily?
Increase doses of opiate by 1/2 to 1/3 each day
How much do you reduce dose of opiate by when switching between opiates and why?
Reduce dose by 1/2 to 1/3 when switching between opiates (e.g. morphine 30 to oxycodone) to prevent overdose
Which one is more potent - oxycodone or morphine
- Oxycodone more potent than morphine
○ More appropriate in pt who cannot consume large qty due to nausea
Patient wants to stop taking gabapentin. How should it be stopped?
Reduce by half every day and stop within 3 days
Stop next day for non-epilepsy indications
Reduced over minimum one week
- Answer = reduced over a minimum of one week for gabapentin and pregabalin
