opioids 2

Question 1

can you use fentanyl in opioid naive patients

Answer 1

NO - MHRA ADVICE!
contraindicated in opioid naive pt. other anagesics and other opioids for non malignant pain need to be used first

Question 2

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

Answer 2

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

Question 3

why should you give repeated intra op doses of fentanyl with care

Answer 3

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

Question 4

true or false - muscle rigidity can occur with IV admin of fentanyl

Answer 4

true

Question 5

IV admin of fentanyl may cause muscle rigidity, which may involve the thoracic (chest) muscles. how can you avoid this

Answer 5

manufacturer advises admin by slow IV injection to avoid
higher doses may require premed with BZDPN and muscle relaxants

Question 6

patient who is on fenttanyl patches says they are unwell. what should you do

Answer 6

if fever is present, monitor them for increased SE as increased absorption is possible

Question 7

how many days are fentanyl patches

Answer 7

3 days (72h)

Question 8

directions for administration of fentanyl patches

Answer 8

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

Question 9

when should pt immediately remove fentanyl patches

Answer 9

breathing difficulties
marked drowsiness
confusion
dizziness
impaired speech
seek prompt medical attention

Question 10

indication for hydromorphine

Answer 10

severe pain in cancer

Question 11

morphine is used in these 2 unlicensed indications for palliative care

Answer 11

treatment of cough and breathlessness at rest in palliative care

Question 12

Name the 24h MR prep of morphine

Answer 12

MXL

Question 13

MHRA - tapentadol (hint sero- and seiz-)

Answer 13

risk of seizures and reports of serotonin syndrome when given with other drugs
can induce seizures; caution in epilepsy or seizure disorders

Question 14

what is the side effect of tapendatol being taken with SSRIs, SNRIs or TCAs, antipsychotics

Answer 14

these drugs lower seizure risk
so increased risk of seizure
also serotonin syndrome