Pain medications Flashcards
A patient is on 5mg IR morphine every 4h.
How much and how often is his PRN dose
Same dose (5mg) Give 1-2hrly
A patient is on 5mg IR morphine every 4h, and taking PRN morphine 6 times during the day.
What should his new 4h dose be?
Calculate previous 24h dose + PRN
= 56 + 56
= 60mg in 24h
Thus he should get 10mg every 4h
A patient is on 30mg MR morphine every 12h.
How much and how often is his PRN dose
PRN dose is 1/6 to 1/10 of 24h dose
6-10 mg (1/6 to 1/10 of 60mg)
Give 1-2hrly
What drug is used to reverse opiate toxicity
Naloxone
In palliative care, what drug is used for pain/ breathlessness in
- normal kidney function
- reduced kidney function
Normal kidney function
MORPHINE
Reduced kidney function
ALFENTANIL
In palliative care, what drug is used for respiratory secretions in
- normal kidney function
- reduced kidney function
Normal kidney function
HYOSCINE HYDROBROMIDE
Reduced kidney function
HYOSCINE BUTYLBROMIDE
In palliative care, what drug is used for nausea in
- normal kidney function
- reduced kidney function
Normal kidney function
CYCLIZINE
Reduced kidney function
HALOPERIDOL
In palliative care, what drug is used for agitation in
- normal kidney function
- reduced kidney function
for both:
MIDAZOLAM
Contraindications to prescribing paracetamol
- liver failure
2. severe renal impairment (eGFR <30)
Contraindications to prescribing NSAIDs
- Peptic ulcer/ GI bleed
- Liver/ renal impairment
- Clotting disorders
- Hypersensitivity (eg asthma)
- Pregnancy
- Hypovolemia
Increased risk of MI and stroke are associated with which COX enzyme
COX2
Contraindications to prescribing all opioids
- Respiratory depression
- Comatose
- Raised ICP/ head injury
What drugs cannot be given with tramadol?
Why?
SSRI/SNRI
Risk of serotonin syndrome.
Tramadol also blocks serotonin/ norepinephrine reuptake
Which drug is normally given for post-operative pain?
Oxycodone (lower risk of opiate toxicity)
What drugs are given for neuropathic pain? Which are 1st line
Amitryptiline, Gabapentin, Pregabalin, Duloxetine
Amitryptiline and Pregabalin are 1st line
What drugs are used for bowel colic/ bladder spasm
Hyoscine butylbromide (buscopan)
What drugs are used for bowel colic/ bladder spasm
Hyoscine butylbromide (buscopan)
What drugs are used for muscle spasm
Baclofen, Diazepam
What drugs are used for bone pain
Bisphosphonates
eg Zolendronic acid
Mechanism of action of bisphosphonates
Encourage apoptosis of osteoclasts, to slow bone loss
Mechanism of action of hyoscine butylbromide
Antimuscarinic
4 signs of opioid toxicity
- Myoclonic jerks
- Pin-point pupils
- Hallucinations, confusion
- Severe respiratory depression
When converting SC morphine to SC alfentanil, how much to give
- routine
- breakthrough pain
1/15 for routine
1/10 for breakthrough pain
Side effects of corticosteroids
- Easy bruising
- Muscle wasting, atherosclerosis
- Euphoria, depression, psychosis
- Thinning skin/poor wound healing
- Hyperglycaemia
- Osteoporosis
- Cushing’s like syndrome