Pain management Flashcards
what should be used for mild pain?
-non-opiates: paracetamol, NSAIDS aspirin
what should be used for mild-moderate pain?
-weak opiates: codeine, dihydrocodeine
-moderate: tramadol
what side effects should be looked out for when using tramadol?
(lower seizure threshold, serotonin syndrome, increased risk of bleed and psychiatric disorder)
what should be used for moderate to severe pain?
-strong opiates: morphine, oxycodone, methadone, buprenorphine, fentanyl
what is the max dose for morphine?
-isnt a set max dose
what is codeine? minimum age? when not to use? avoid in who?
-patients over 12 years can use
-dont use in children under 18 who had tonsils removed due to sleep apnoea
-avoid in patients who are ultra-rapid metabolisers (afro caribbean) due to toxicity
-avoid in breast feeding
what are some opiates side effects?
-act on mu-pathway causing:
-dry mouth
-constipation
-CNS depression
-nausea and vomiting
-hypotension
-miosis (pupil constriction)
what are side effects of strong opiates due to prolonged use?
-hypogonadism (pinch would feel at lot worse now), adrenal insufficiency, hyperalgesia
what should be used for strong opiates overdose?
naloxone
who should avoid strong opitates?
paralytic ileus, respiratory disease and head injury
what should be given for breakthrough pain?
1/6 to 1/10th of total daily dose every 2-4hrs
what is the measurement for dose increase each day of opiates?
1/2 or 1/3
what is the measurement for changing opitates?
should reduce 1/2 to 1/3 to prevent overdose
why would you change morphine to oxycodone to morphine
-oxycodone is more potent than morphine- more appropriate in patients who cant consume large quantities due to nausea
what is some counseling for patches?
-avoid heat, dry hairless area, rotate the site
-in fentanyl patch remove if any signs of toxicity
