Analgesia

Question 1

What is the normal regular oral dose of paracetamol?

Answer 1

1g qds

Question 2

Treatment of moderate pain?

Answer 2

Weak opioid + paracetamol

Question 3

Examples of weak opioid doses?

Answer 3

Co-codamol 30/500, two tablets up to 4 times daily

Codeine 30mg qds

Question 4

Management of severe pain?

Answer 4

Continue step 2 analgesia, add morphine PRN; re-assess, if pain continues then consider switching to regular strong opioid

Question 5

Signs of opioid toxicity? (5)

Answer 5

Sedation
Hallucinations/delirium
Myoclonus
Respiratory depression
Pinpoint pupils

Question 6

Initial dose of naloxone?

Answer 6

400 micrograms

Question 7

If commencing with immediate release morphine, how should the dose be titrated?

Answer 7

5mg every 4 hours,. and PRN for breakthrough pain. Convert to modified release when stable by dividing total daily dose by 2, and prescribe as modified release morphine 12-hourly

Question 8

How should breakthrough morphine be prescribed?

Answer 8

1/6th of the regular 24 hour oral morphine dose