Pharmacy teaching 1

Question 1

Name examples of immediate-release opioids

Answer 1

Question 2

Name the examples of modified release opioids

Answer 2

Question 3

Name most potent to least potent opioids

Answer 3

Question 4

Potency of opioids (as compared to PO morphine)

Answer 4

Question 5

Opioids safe to use in renal impairment

Answer 5

Question 6

What opioids are unsafe to use in renal impairment?

Answer 6

Question 7

Example of opioid prescription for an opioid-naive patient vs regular-opioid user

Answer 7

Question 8

How to convert opioids?

Answer 8

Question 9

Work out breakthrough analgesia

Answer 9

• divide the dose by: 6 and 10
• prescribe range: BD 30mg = 60mg in 24 hr
• 60 mg/ 10 and /6 = 6-10 mg

so if pt has a bit of pain give 6mg if a lot 10 mg as a breakthrough

perhaps round 6 mg to 5mg (as per tablet)

Frequency every 4-6 hours (PRN)

Question 10

Signs and symptoms of opioid toxicity

Answer 10

Question 11

How do you treat opioid toxicity?

Answer 11

Naloxone

400mcg initially, then at 1-minute intervals

Question 12

Can eGFR be always used in the assessment of renal function (in terms of drug prescribing)?

Answer 12

No

eGFR cannot be used in:

• children
• elderly
• extreme body weights
• catabolic states
• pregnancy

We use instead Cockroft and Gault Formula

Question 13

Drugs that cause AKI

Answer 13

Question 14

Medications to review in AKI

Answer 14

Question 15

Management of hyperkalaemia

(with doses)

• indications for dialysis

Answer 15

Question 18

• prescribe fluids for this patient
• what is the indication for fluid therapy?

Answer 18

We give fluids → reassess pt after 15 mins → if not OK can repeat fluids up to 2L

Question 19

Work out daily requirements and prescribe the fluids

Why don’t we use 0.9% saline?

Answer 19

Daily requirements:

• 1975 - 2370 mL/day of fluids
• 79 mmol/day Na+, Cl-, K+
• 50-100 g / day glucose

With 0.9% sodium chloride we get 154 mmol NaCl

With 0.18% sodium chloride we get 30mmol NaCl

That’s why we use 0.18% as maintenance, otherwise, pt would be overloaded of sodium

We can give pt max 40 mmol/1L of fluid of KCl

Question 20

How many mmols of KCl can we give max in the 1L bag of fluid?

Answer 20

We can give pt max 40 mmol KCl in 1L of fluid

Question 21

How to find info about fluids in BNF?

Answer 21

BNF ⇒ Treatment Summaries ⇒ Fluids and electrolytes

Question 22

Which of these opioids is stronger than morphine?

A. Codeine

B. Fentanyl

C. Dihydrocodeine

D.Tramadol

Answer 22

B. Fentanyl

Question 23

Under which section BNF provides information about opioid prescribing?

Answer 23

Prescribing in palliative care

Question 24

Can Diamorphine be used in renal impairment?

Answer 24

No, it’s not safe in renal impairment

Only safe are: Oxycodone, Fentanyl, Alfentanil

Question 25

Which fluid should we use in fluid resuscitation?

Answer 25

Either Hartman’s or 0.9% Sodium Chloride