Opioids

Question 1

What are the warning signs of opioid toxicity?

Answer 1

Respiratory depression, bradycardia, hypotension, extreme sleepiness, confusion, reduced concentration, cyanosis, vivid dreams, hallucinations, nightmares, convulsions, pinpoint pupils.

Question 2

What psychological behaviours are associated with opioid dependence?

Answer 2

Craving, compulsive use, continued use despite harm.

Question 3

When do opioid withdrawal symptoms occur?

Answer 3

When the dose is stopped straight away or the dose is tapered down too quickly.

Question 4

What are the signs and symptoms of opioid withdrawal?

Answer 4

Sweating, restlessness, tremor, increase in normal pain, diarrhoea, N&V, anxiety.

Question 5

What is required when a patient develops tolerance to an opioid?

Answer 5

Increasing doses are required to achieve the same therapeutic effect.

Question 6

When a patient is on an opioid, what symptoms/side effects should be monitored?

Answer 6

Pain and sedation.

Question 7

Opioids show an enhanced hypotensive and sedative effect when given with what drug?

Answer 7

Alcohol.

Question 8

Which opioid pain killer can enhance the anticoagulant effect of coumarins?

Answer 8

Tramadol.

Question 9

There is a reduced effect of fentanyl, morphine, codeine, methadone, and alfentanil when they are given with which drug used to treat TB?

Answer 9

Rifampicin.

Question 10

There is possible CNS excitation and/or depression when opioids are given with which drugs?

Answer 10

MAOis.

Question 11

How should dose increases for opioids be handled?

Answer 11

Dose increases should be by no more than 50% of the previous dose?

Question 12

How should opioid treatment be stopped?

Answer 12

Slowly in a tapered manner, not quickly or immediately.

Question 13

What dose of opioid therapy should be used for the treatment of breakthrough pain?

Answer 13

1/10th to 1/6th of the daily background opioid dose.

Question 14

Describe the analgesic ladder.

Answer 14

Non-opioid > weak opioid (codeine, dihydrocodeine, meptazinol) > strong opioid (morphine, buprenorphine, diamorphine, fentanyl, oxycodone, tapentadol, tramadol).

Question 15

When codeine is metabolised by the liver, what is produced?

Answer 15

Morphine.

Question 16

What are the contraindications for codeine use?

Answer 16

Children <12 years old, patients of any age known to be CYP2D6 ultra-rapid metabolisers, breastfeeding mothers, all children under 18 years who have had surgery to remove tonsils or adenoids for sleep apnoea, all children under 18 with respiratory problems.

Question 17

When a patient using fentanyl patches has a fever, what course of action should be taken?

Answer 17

The patient should be monitored for increased side effects due to the increased release of the drug when the temperature increases.

Question 18

What counselling should be given to patients on fentanyl patches?

Answer 18

They should avoid exposing the patch to increased temperatures such as hot shower/baths, saunas, etc.

Question 19

Due to long duration of action, for how long should patient who experience adverse effects when taking transdermal fentanyl be monitored for?

Answer 19

Up to 24 hours after patch removal.

Question 20

Due to the risk of fatal respiratory depression, what patient group do fentanyl patch manufacturers recommend they are used in?

Answer 20

In opioid tolerant patients.

Question 21

When should fentanyl patches be immediately removed? What should a patient do after this?

Answer 21

In cases of breathing difficulties, marked drowsiness, confusion, dizziness, or impaired speech. Patients/carers should seek prompt medical attention.