Pharmacy teaching 1 Flashcards
Name examples of immediate-release opioids
Name the examples of modified release opioids
Name most potent to least potent opioids
Potency of opioids (as compared to PO morphine)
Opioids safe to use in renal impairment
What opioids are unsafe to use in renal impairment?
Example of opioid prescription for an opioid-naive patient vs regular-opioid user
How to convert opioids?
Work out breakthrough analgesia
- 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)
Signs and symptoms of opioid toxicity
How do you treat opioid toxicity?
Naloxone
400mcg initially, then at 1-minute intervals
Can eGFR be always used in the assessment of renal function (in terms of drug prescribing)?
No
eGFR cannot be used in:
- children
- elderly
- extreme body weights
- catabolic states
- pregnancy
We use instead Cockroft and Gault Formula
Drugs that cause AKI
Medications to review in AKI
Management of hyperkalaemia
(with doses)
- indications for dialysis
- prescribe fluids for this patient
- what is the indication for fluid therapy?
We give fluids → reassess pt after 15 mins → if not OK can repeat fluids up to 2L
Work out daily requirements and prescribe the fluids
Why don’t we use 0.9% saline?
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
How many mmols of KCl can we give max in the 1L bag of fluid?
We can give pt max 40 mmol KCl in 1L of fluid
How to find info about fluids in BNF?
BNF ⇒ Treatment Summaries ⇒ Fluids and electrolytes
Which of these opioids is stronger than morphine?
A. Codeine
B. Fentanyl
C. Dihydrocodeine
D.Tramadol
B. Fentanyl
Under which section BNF provides information about opioid prescribing?
Prescribing in palliative care
Can Diamorphine be used in renal impairment?
No, it’s not safe in renal impairment
Only safe are: Oxycodone, Fentanyl, Alfentanil
Which fluid should we use in fluid resuscitation?
Either Hartman’s or 0.9% Sodium Chloride
