Pain and prescribing Flashcards
What is nociceptive pain?
normal nervous system identifying a lesion causing tissue damage
Can be somatic or visceral
What is neuropathic pain?
multifunctioning nervous system input, nerve structure is damaged
What drugs can be used for neuropathic pain?
Amitriptyline - 10-25mg nocte
Gabapentin - 300mg TDS over 3/7
Pregabalin - 75mg BD
What are some of the drugs used in step 2 of WHO pain ladder?
Dihydrocodeine
Codeine phosphate
Tramadol
Co-codamol
What are some of the drugs used in step 3 of WHO pain ladder?
Oxycodone
Morphine
Fentanyl
Diamorphine
What is the best type of pain control for bone mets?
NSAIDs
Radiotherapy
Bisphosphonates
Surgery
responds less well to opioids
What is the best way to manage liver pain?
- Steroids
- NSAIDs
Which type of pain responds poorly to opioids?
Neuropathic
How do you step up from max codeine to morphine?
Max dose of codeine = 240mg
equal to 24mg of morphine
To step up needs to be >24mg
e.g Morphine SR 15mg BD plus PRN 5mg
What are the most common side effects of morphine when used for persistent pain
- Constipation
- Dry mouth
- N&V
- Drowsiness/ sedation
How do you up titrate morphine dose?
TDD (SR + PRN) / 2 = new SR dose
TDD / 6 = new PRN dose
How do you convert from oral to SC morphine?
Divide by 2
how long do fentanyl patches take to achieve steady state?
Take 12-24 hours
What is the smallest patch of fentanyl and what is it equivalent to?
12mcg/ hour equivalent to 45mg morphine/24 hours
What are some of the signs of opioid toxicity?
- Pinpoint pupils
- Hallucinations
- Drowsiness
- Vomiting
- Confusion
- Myoclonic jerks
- Respiratory depression
