Codeine Flashcards

1
Q

Give 2 examples of codeines

A
  • Codeine phosphate

- Dihydrocodeine

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2
Q

What is codeine?

A

A weak opioid

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3
Q

What is the mechanism of action of codeine?

A

Simultaneously acts at the opioid receptors to cause euphoria and analgesia, and at the medulla to suppress the cough reflex

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4
Q

What are the routes of delivery of codeine?

A
  • PO

- IM

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5
Q

Is codeine available as slow release?

A

Yes

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6
Q

Why should codeine not be given IV?

A

Causes reaction similar to anaphylaxis

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7
Q

What are the indications for codeine?

A
  • Mild to moderate pain of acute or chronic nature
  • Diarrhoea
  • Cough suppression
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8
Q

In what conditions are all opioids, including codeine, contraindicated?

A
  • Respiratory depression
  • Head injury
  • Raised ICP
  • Paralytic ileus
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9
Q

What conditions is codeine contraindicated in?

A
  • Acute ulcerative colitis
  • Antibiotic-associated colitis
  • Known ultra-rapid codeine metabolisers
  • <18 year olds who have undergone tonsillectomy to treat sleep apnoea
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10
Q

Describe the use of codeine in > 12 year olds?

A

MHRA has recommended that codeine is only used to treat acute severe pain in > 12 year olds if other non-opioid analgesia has failed to control the child’s pain

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11
Q

When should codeine be avoided?

A
  • Breastfeeding

- Renal and hepatic impairment

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12
Q

How does the metabolism of codeine affect the risk of taking it?

A

There is variation in metabolism, but some patients being CYP2D6 ultra-rapid codeine metabolisers and are at high risk of opioid toxicity, whereas other patients are slow metabolisers

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13
Q

What monitoring is required with codeine?

A

Review pain control within hours of taking codeine in acute pain or schedule a timely review of pain control in patients with chronic pain

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14
Q

What might codeine interact with?

A
  • Alcohol
  • Sedatives
  • Hypnotics
  • General anaesthetic agents
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15
Q

What might happen if codeine is given with these drugs?

A

Depress the CNS and increase risk of respiratory depression

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16
Q

What are the common side effects of codeine?

A
  • Nausea and vomiting
  • Constipation
  • Respiratory depression
  • Hypotension
  • Paralytic ileus
  • Provoked seizures by lowering seizure threshold
17
Q

What patient counselling is required with codeine?

A
  • Impairment of normal abilities
  • Bowel obstruction
  • Breastfeeding
  • Alcohol
18
Q

What should the patient be told regarding impairment of normal abilities with codeine?

A

Codeine may affect your ability to drive or operate machinery due to sedative effects. Should not drive or operative machinery if feel dizzy or drowsy after taking this medication. Driving at the start of opioid therapy, and following dose changes, is not recommended

19
Q

What should the patient be told about bowel obstruction with codeine?

A

Excessive codeine can cause mechanical and paralytic bowel obstruction, so patients should be warned to stop taking codeine if bloating or distention occur

20
Q

What should the patient be told about breastfeeding with codeine?

A

It is preferable to avoid codeine since it enters the breastmilk in small amounts

21
Q

What should the patient be told about alcohol with codeine?

A

Avoid alcohol whilst taking opioids due to the increased risk of respiratory depression, since both drugs depress the CNS