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CPT > WHO analgesic ladder > Flashcards

WHO analgesic ladder Flashcards

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1
Q

What meds can be given on step 1 of the WHO ladder?

A

Non-opioids:
Paracetamol
NSAIDs

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2
Q

How does paracetamol work?

A

No one knows

Mild analgesic, antipyretic properties

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3
Q

How do NSAIDs work?

A

Mild analgesics with anti-inflammatory effect

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4
Q

What meds can be given on step 2 of the WHO ladder?

A

Weak opioids
Codeine
Tramadol

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5
Q

How does codeine work?

A

Conversion in the liver to morphine- normally 10%

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6
Q

What can codeine be used for?

A

Analgesia, cough suppression, anti-diarrhoeal

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7
Q

What are common side effects of codeine?

A

Constipation
Drowsiness
Rash

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8
Q

How does tramadol work?

A

Complex MOA. Binds u-opioid receptors, inhibits reuptake of 5-HT and NA

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9
Q

What are side effects of tramadol?

A

Less constipating than codeine
Respiratory depression
Small risk of serotonin syndrome when combined with other CNS drugs

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10
Q

What meds can be given on step 3 of the WHO ladder?

A 
Potent opioids
Morphine
Oxycodone
Fentanyl
Diamorphine

Prescribe both regular (sustained release) and PRN (immediate release) for chronic conditions
Prescribe PRN for short term e.g. nephrolithiasis

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11
Q

What is the normal starting dose of morphine?

A

20-30mg per day

If needing >2 doses of morphine for breakthrough pain in 24 hours, increase background amount

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12
Q

What are common SEs of morphine?

A

Constipation
Nausea
Vomiting
Dry mouth

Prescribe prophylactic laxative- faecal softener ± stimulant

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13
Q

What is oxycontin?

A

Sustained release oxycodone

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14
Q

What is oxynorm?

A

Immediate release oxycodone

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15
Q

What are the side effects of oxycodone

A

Less constipating

More sedating

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16
Q

How does fentanyl work?

A

Synthetic opioid 200x more potent than morphine

17
Q

How is fentanyl given?

A

Patch- 72 hours of continuous release

18
Q

What may change fentanyl release?

A

Exposure to external heat-increases

19
Q

Where is diamorphine used?

A

Palliative care primarily due to low injection volume

Less nausea and hypotension

20
Q

How is dosing different in palliative care?

A

No maximum dose

Look at start of BNF

21
Q

How does administration of drugs change in palliative care?

A

Often need to change route of administration with time- need to convert correctly

PO morphine to IM or SC need to half the dose

22
Q

What is the conversion between oral morphine and SC diamorphine?

A

Divide dose by 3

23
Q

What opiates are controlled prescription drugs?

A

Morphine
Diamorphine
Oxycodone
Fentanyl

24
Q

What opiates are not controlled prescription drugs?

A

Codeine
Tramadol
Dihydrocodeine
Diazepam

CPT (24 decks)

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