Opioids Practice Points

Question 1

People mostly at risk of opioid misuse?

Answer 1

1. Personality dysfunction or mental illness
2. History of substance misuse
3. Poor social support

Question 2

Use of opiods should be used for what kind of pain/care?

Answer 2

Acute pain
And
Palliative care

Question 3

Long acting opioids?

Answer 3

Buprenorphine

Methadone

Question 4

Atypical opioids

Answer 4

Tapentadol
= inhibits noradrenaline reuptake

Tramadol
= inhibits noradrenaline and serotonin reuptake

Question 5

Which is preferred
Tapentadol or tramadol?
Why?

Answer 5

Tapentadol is proffered.

As tramadol inhibits serotonin reuptake and is a CYP2D6 substrate

Question 6

Conversion factors for Opioids
Morphine 1
Oxycodone
Hydromorphone

Answer 6

Morphine 1
Oxycodone 1.5
Hydromorphone 5

Question 7

Factors affecting opioid use/dose =
Weight or age?
Why?

Answer 7

Age.

1. Pharmacokinetic changes with old age:
   Inc. body fat + Inc. Total body water = decrease Volume distribution of hydrophilic drugs (morphine)
2. Pharmacodynamic changes:
   Increase brain sensitivity

Question 8

Which opioid is used in renal impairment?

Answer 8

Fentanyl

Methadone

Question 9

Calculate change in opioid doses

Question 10

Calculate incident and breakthrough doses

Answer 10

Incident pain = may require higher doses

Breakthrough pain = not controlled by analgesia

Question 11

How to treat opioid induces constipation?

Answer 11

1. Always give laxatives with regular opioids
   Eg
   Docusate and senna
   Or
   Osmotic laxatives (macrogel/lactulose)
2. Do not use bulk- forming laxatives
   (May worsen constipation)

Question 12

Conselling points for fentanyl patches

6