Pain management Flashcards
Paracetamol dose
1g QDS
Ibuprofen Cautions
Elderly
renal impairment
GI tract disease
Avoid in dehydrated patients
Ibuprofen Dose
400 mg TDS
Consider prescribing PPI
Ibuprofen Disadvantages
GI and renal side effects
bleeding risk
Diclofenac Caution
Elderly
renal impairment
GI tract disease
Avoid in dehydrated patients
Diclofenac dose
25-50 mg TDS
consider prescribing PPI
Weak Opioids
Codeine
Dihydrocodeine
Partial opioids
Tramadol
Buprenorphine
Full opioids
Morphine Oxycodone Fentanyl Methadone Pethidine
Pain ladder
1) paracetamol +/- NSAID
2) Add a weak opioid (codeine, dihydrocodeine) or tramadol
3) Replace weak with strong opioid (morphine)
Regular pain relief for No pain
Nil
PRN for no pain
Paracetamol 1g Q6h
Regular pain relief for mild pain
Paracetamol 1g Q6h
PRN pain relief for mild pain
Codeine 30 mg Q6h
OR tramadol
Regular pain medication for severe pain
Co-codamol 30/500 2 tablets Q6h
PRN pain relif for severe pain
Morphine sulfate 10 mg Q6h
Neuropathic pain
amitryptyline 10 mg nocte
Pregabalin 75 mg Q12
Painful diabetic neuropathy
duloxetine 60 mg
Daily paracetamol maximum
4g
Rule for PRN morphine
PRN morphine dose is calculated as 1/6th the total daily dose, given every 4-6hours
If changing the PRN dose, must also change daily dose
Tramadol side effects
agitation/hallucination particularly in elderly
Codeine side effect
Constipating
Maximum codeiene dose
240 mg
Max tramadol
400 mg
Occasional pain
PRN
Constant pain
Regular
WHO pain ladder step 2
Weak opioids such as codeine or tramadol + paracetamol and NSAID for moderate to severe pain
WHO pain ladder step 3
Strong steroid such as morphine in addition to paracetamol for severe pain
Safe in pregnancy
Codeine
