Analgesia

Question 1

What constitutes simple analgesia?

Answer 1

Paracetamol

NSAIDs

Question 2

How do you prescribe paracetamol?

Answer 2

1g QDS max dose

Question 3

What are some cautions and contraindications to paracetamol?

Answer 3

Cautions:
Liver impairment
Severe cachexia
(reduce dose)

Question 4

What are weak opioids?

Answer 4

Coedine
Dihydrocodeine
Tramadol

All have a ceiling effect on analgesia - can only be given so much in 24hrs so may not be enough opioid to control pain

Question 5

MORE CARDS ON WEAK OPIOID PRESCRIPTION

Answer 5

..

Question 6

What are weak opioids?

Answer 6

Coedine (1/10th as potent as oral morphine)
Tramadol (1/10th as potent as oral morphine)
Dihydrocodeine

All have a ceiling effect on analgesia - can only be given so much in 24hrs so may not be enough opioid to control pain

Question 7

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Answer 7

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Question 8

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Answer 8

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Question 9

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Answer 9

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Question 10

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Answer 10

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Question 11

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Answer 11

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Question 12

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Answer 12

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Question 13

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Answer 13

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Question 14

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Answer 14

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Question 15

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Answer 15

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Question 16

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Answer 16

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Question 17

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Answer 17

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Question 18

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Answer 18

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Question 19

What are strong opioids?

Answer 19

Morphine
Diamorphine
Oxycodone (2x more potent than morphine)
Buprenorphine
Fentanyl (very strong - ? - dont start on it)

Question 20

What do you need to consider before starting a strong opioid?

Answer 20

Comorbidities

Renal function

Question 21

What forms can you get strong opioids in? (morphine + oxycodone)

Answer 21

Modified release - lasts 12hrs for background pain

Immediate release - lasts 4hrs for breakthrough pain

Question 22

What forms can you get strong opioids in? (morphine + oxycodone)

Answer 22

Modified release - MR - lasts 12hrs for background pain

Immediate release - IR - lasts 4hrs for breakthrough pain

Question 23

What are some other side effects of opioids?

Answer 23

Common:
Constipation 
Nausea 
Sedation 
Dry mouth 

Less frequent:
Psychomimetic effects
Confusion
Myoclonus

Rare:
Allergy
Resp depression
Pruritis

Question 24

When should you prescribe opioid patches?

Answer 24

For stable opioid responsive pain

Indications:
Intolerable side effects
Oral route difficulties - dysphagia, non-compliance
Renal impairment

Takes 1-3 days to reach analgesic concentrations - do not use for acute pain

Apply to hairless, dry and non-inflamed skin

Avoid heat pads as increases rate of absorption - also be mindful when patients are hot e.g. fever/sepsis

Question 25

When should you prescribe opioid patches?

Answer 25

For stable opioid responsive pain Indications: Intolerable side effects Oral route difficulties - dysphagia, non-compliance Renal impairment Takes 1-3 days to reach analgesic concentrations - do not use for acute pain Replace at same time every week (?) Apply to hairless, dry and non-inflamed skin Avoid heat pads as increases rate of absorption - also be mindful when patients are hot e.g. fever/sepsis

Question 26

When should you use syringe drivers?

Answer 26

Injectable opioids are 2x as strong so oral dose may need downscaling accordingly If someone is stable on a patch - keep them on it whilst on the driver

Question 27

What opioids are safest in renal impairment?

Answer 27

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Question 28

What are adjuvant analgesics? What are they used for?

Answer 28

Antidepressants Antiepileptics MORE ON SLIDES

Question 29

What are adjuvant analgesics? What are they used for?

Answer 29

Antidepressants Antiepileptics MORE ON SLIDES

Question 30

What painkillers can put someone at risk of developing iron deficiency anaemia?

Answer 30

NSAIDs - due to the inhibitory effects on the production of prostaglandins by the gastric mucosa