Pain

Question 1

Name some weak/ moderate opioids

Answer 1

Tramadol
Codeine
Dihydrocodeine

Question 2

Indications of weak/moderate opioids

Answer 2

Mild to mod pain

Question 3

Moa weak/moderate opioids

Answer 3

Metabokised in liver to morphine (from codeine) and dihydromorphone (from Dihydrocodeine)

Metabolites stronger against mew receptors.

10% caucasions have less active metabolising enzyme = cyp 2D6 - ineffective for them.

Tramadol = synthetic analogue of codeine with koderate strength. It also affects serotonorrgic and adrenergic paths where it acts as SNRI

Question 4

Se of weak/moderate opioids

Answer 4

• N and V
• dizzy
• drowsy
• constipation
• neuro and resp depression
• tramadol less constipation and resp depression
• codeine and Dihydrocodeine should not be given IV - anaphylaxis style reaction

Question 5

Caution when using weak/moderate opioids

Answer 5

• in significant resp distress
• reduce dose in renal and hepatic impaired and elderly
• tramadol lowers seizure threshold so avoid in epilepsy esp not uncontrolled epilepsy

Question 6

Interactions of weak/moderate opioids

Answer 6

• other sedating drugs e.gm benzo, TCA. SsRI, antipsychotics

- do not use tramadol with other drugs thag reduce seizure threshold. Also avoid wth other serotonergic drugs

Question 7

Common starting dose for codeine/Dihydrocodeine

Answer 7

30mg 4hrly

Question 8

Common starting dose for tramadol

Answer 8

50mg 4hrly