Pain management Flashcards
Outline the steps in the WHO pain ladder
What are the considerations in paracetamol dosing in children
Oral admin: Check which 2 year age band they fall into. Prescribe in mg NOT ml
IV: Use dosing table. Only 50ml vial if 33kg or under
Outline the paracetamol doses for adults
Oral: 4g in 24 hours
- Less if under 50kg, overweight don’t need increases
IV: 3g in 24 hours
- 4hrs between admin, 6 if renal impairment
What are examples of COX-1 and COX-2 inhibitors
COX-1: Ibuprofen, diclofenac
COX-2: -Coxibs
What are the risks with NSAIDs
GI irritation, bleeds
Increased cardiac events (diclofenac, high dose ibuprofen)
What meds need reviewed when starting an NSAID?
Start PPI, Review/stop anticoagulants
Which conditions need considered in NSAID prescription?
Asthma
Liver impairment
Renal impairment
What is the dosage of aspirin
300-900mg 4-6 hourly
450-900mg 4 hourly if rectal
What dose of the following drugs is equivalent to 10mg MST:
Hydromorphone
Diamorphine
IV/IM/SC morphine
Oxycodone
Codeine
Tramadol
Dihydrocodone
Hydromorphone: 2mg
Diamorphine: 3mg
IV/IM/SC morphine: 5mg
Oxycodone: 6.6mg
Codeine/ Tramadol/ Dihydrocodone: 100mg
Adverse effects of weak opioids
Constipation
Drowsiness
What route of codeine admin causes anaphylaxis?
IV
How is codeine metabolised?
Liver via P450
What are the difficulties in converting tramadol to morphine?
Acts on multiple opioid receptors + serotonin/noradrenaline
Ranges from 1:10 to 1:6 the morphine dose
What are the advantages and disadvantages of tramadol
Advantages:
- Less GI risk, constipation, resp depression
- Chronic and neuropathic pain
Disadvantages:
- Nausea and vomiting
- Affects seizure threshold
- Some patients have no response
List 3 strong opioids
Morphine
Diamorphine
Oxycodone
Fentanyl
Buprenoprhine
Methadone
What adjuvant analgesics can be used
Antidepressants: TCAs (~1/10th psychiatric dose) + SSRIs
Anticonvulsants: Carbamazepine, Gabapentin, Lamotrigene, Pregabalin
NMDA receptor antagonists: Ket, Mg2+
What is the typical dosing regimen for…
Amitiptyline
Duloxetine
Gabapentin
Pregabalin
Amitiptyline: 10mg nightly, up to 75mg
Duloxetine: 60mg daily, up to 120mg
Gabapentin: specialist
Pregabalin: 150mg over 2-3 doses, up to 600mg
What are the features of local anaesthetic toxicity?
What drug can be considered in its reversal?
Mild: Visual changes, paraesthesia
Mod: Reduced GCS, convulsions
Fatal: Acute cardio-resp arrest
Intralipid
