Analgesia

Question 1

Name three weak opioids

Answer 1

Codeine
Dihydrocodeine
Tramadol

Question 2

Name two stronger opioids

Answer 2

Oxycodone
Morphine

Question 3

Name three super strong opioids

Answer 3

Fentanyl
Methadone
Diamorphine

Question 4

Do you pinch the skin for a SC injection or IM injection?

Answer 4

SC injection - pinCH skin

Question 5

Do you gently pull down on the skin for SC injection or IM injection?

Answer 5

IM injection - pull down

Question 6

Which opioid do you use in someone with severe pain, if they are MILDLY renally impaired?

Answer 6

Oxycodone

Question 7

Which opioid do you use in someone with severe pain, if they are SEVERELY renally impaired?

Answer 7

Fentanyl
Buprenorphine

Question 8

When do you use methadone?

Answer 8

To help people through drug addiction

Question 9

What is the conversion range from PO codeine to PO morphine?

Answer 9

Divide dose of codeine by 10
10:1

Question 10

What is the conversion range from PO codeine to PO morphine?

Question 11

What is the maximum dose of codeine you can give in 24 hours?

Answer 11

Codeine — 30 to 60 mg every 4 hours when necessary (maximum 240 mg in 24 hours)

MP reference: Bay A in Thomas Audley -> A is like a triangle -> three corners -> three weak opiods -> first corner has a microwave/CODEsafe (codeine) with a 24hr timer and a happy 10th birthday badge (24x10=240). Inside there’s a balloon with sylvia plath’s face (sylvia + microwave/oven suicide :[ )

Question 12

What is the maximum dose of dihydrocodeine you can give in 24 hours?

Answer 12

Dihydrocodeine — 30 mg every 4 to 6 hours when necessary (maximum 180 mg in 24 hours).

A hose pipe is connected to the code safe (water spraying at code safe -> dihydrocodeine). The hose pipe has a face and it’s fanning itself with a protractor (180 degrees for 180mg).

Question 13

What is the maximum dose of tramadol you can give in 24 hours?

Answer 13

Tramadol — 50 to 100 mg every 4 to 6 hours when necessary (usual maximum 400 mg in 24 hours).

The last corner of the triangle has a TRAM arriving from Croydon with 100 ladybirds with four dot spots on their back (4x100=400).

Question 14

How do you convert from oral codeine to oral morphine?

Answer 14

PO Codeine to PO morphine -> divide by 10

Question 15

How do you convert from oral tramadol to oral morphine?

Answer 15

PO tramadol to PO morphine -> divide by 10

Question 16

How do you convert from oral morphine to oral codeine?

Answer 16

Times by ten

Question 17

How do you convert from oral morphine to oral tramadol?

Answer 17

Times by ten

Question 18

In which scenario would you prescribe oxycodone over morphine and why?

Answer 18

Mild renal impairment
If the pt has SE - Oxycodone causes less sedation, vomiting and pruritis than morphine but oxycodone does cause more constipation

Question 19

How do you convert from oral morphine to oral oxycodone?

Answer 19

Divide by 1.5-2

Question 20

How do you convert from oral dihydrocodeine to oral morphine?

Answer 20

PO dihydrocodeine to PO morphine -> divide by 10

Question 21

How do you convert from oral morphine to oral dihydrocodeine?

Answer 21

Times by ten

Question 22

Best choice of drugs for pt with CKD

Answer 22

Buprenorphine, alfentanil, and fentanyl are the safest opioid choices in patients with renal impairment.

Question 23

Why is buprenorphine safe in patients with renal impairment?

Answer 23

Buprenorphine undergoes predominantly hepatic metabolism with minimal renal excretion. It is eliminated primarily through the biliary system, with less than 30% excreted in urine.