pain management Flashcards
outline the pain management scale
1: non opiates
2: weak opiates
3: strong opiates
what is the most common drug used in step 2 of pain management, and what is its ceiling dose
codeine phosphate
ceiling dose: 240 mg in 24 hrs ( 60 QDS)
what is the ratio between strengths of codeine and morphine
10:1
e.g 240 mg of codeine = 24 mg morphine
when would you consider reviewing someones analgesia based on PRN use
when titrating: more than 6 PRNs in 24 hrs
on stable dose: consistently needing more than 2 PRNs suggests to review background dose
what are the different forms of PRN morphine often given
oromorph (immediate release morphine)
if no safe swallow: subcut
how does the strength of subcut vs oral morphine compare
2:1
e.g 10 mg oral = 5 mg subcut
what can you use to calculate new background dose and PRN of morphine
TDD/2 = new morphine SR dose
TDD/6 = new breakthrough dose
describe fentanyl patch
transdermal opiate
requires 12-24 hours to reach steady dose
replaced every 3 days
what should be prescribed when starting someone on an opiate
PRN antiemetic (often metoclopramide)
laxative (generally laxido/ movicol)
causes to consider for opiate toxicity
AKI
error in prescribing
escalating dose to quickly
has had intervention which has reduced pain without reducing dose of morphine
give some examples of step 1 analgesics
paracetamol +/- NSAID
give some examples of step 2 analgesics
tramadol (less constipation but more n&v)
codeine
dihydrocodeine
give some examples of step 3 analgesics
morphine (first line unless significant renal impairment)
oxycodone
diamorphine
side effects of opiates
n&v
constipation
confusion / drowsiness
dry mouth
respiratory depression
urinary retention
puritus
what are some classes of adjuvants used in pain management
drugs which the primary indication isnt pain
antidepressants (amitrip, duloxetine, pregabalin)
anticonvulsants (gabapentin)
benzodiazepines
steroids (helps reduce swelling, eg brain or liver mets)
bisphosphonates (used in bony mets)
