Pain Management unit 1 Flashcards
Pharmacotherapeutic Intervention
By mouth
*By clock
*By ladder
By the
mouth
the least invasive and safest method.
By the
clock
most oral analgesics act only for 4 hours or less,
should be prescribed 4 hourly to achieve therapeutic effects.
By the
ladder
WHO’s pain ladder
- dose must be titrated until:
- the maximum recommended dose is reached
- the pain is relieved
- or the patients experience serious side effects.
WHO’s Pain Ladder
step 1
STEP 1
Non-opioids
Paracetamol, NSAID,
COX-2 inhibitors
± adjuvant analgesic
WHO’s Pain Ladder
step 2
STEP 2
Weak opioids
Tramadol, Codeine
± adjuvant analgesic
WHO’s Pain Ladder
step 3
Strong opioids
Immediate release:
Morphine solution
Oxycodone
Methadone
Controlled release:
Morphine Sulphate Tab
Oxycontin
Transdermal Fentanyl
Adjuvant
Analgesics
Helpful in neuropathic pain, can be added in any
steps in WHO Pain Ladder
Tricyclic antidepressants
Anticonvulsants
-Gabapentin
-Pregabalin
Topical
-Lignocaine
Steroid
-Dexamethasone
Morphine
Commonest strong opioid used for palliative patients.
Used for moderate to severe pain; and dyspnea.
- Liquid:
- Mist Morphine Solution (1mg/ml)
- Oramorph Morphine syrup (2mg/ml)
- RA-Morph(Rapid Acting) Morphine solution (1mg/ml)
- Tablet: Morphine Sulphate (Sustained-Released) Tablet, also known as MST (10mg /30mg tablets). Cannot be cut/crushed.
- Injectable: Per ampoule Morphine (10mg/ml) given subcutaneously or
intravenously
Liquid morphine
Mist Morphine Solution (1mg/ml)
* Oramorph Morphine syrup (2mg/ml)
* RA-Morph(Rapid Acting) Morphine solution (1mg/ml)
Tablet morphine
Morphine Sulphate (Sustained-Released) Tablet, also known as MST (10mg /30mg tablets).
Cannot be cut/crushed.
Injectable morphine
Injectable: Per ampoule Morphine (10mg/ml) given subcutaneously or
intravenously
Common side effects of Morphine
constipation, nausea, vomiting, sedation and confusion.
_______________ are needed for ALL patients on Morphine.
Laxatives
Morphine Toxicity
Myoclonic jerks, pinpoint pupils and respiratory depression