Opioid and opiate

Question 1

The main opioid side effects are

Answer 1

• Gastrointestinal: Dry mouth, Nausea/vomiting, constipation
• Neuropsy-chological: sedation, cognitive dysfunction,Delirium, myoclonus, hyperalgesia/allodynia, seizure, vertigo, urinary retention
• Resp: suppresion, edema
• Derm: Pruritus, sweating
• Hormone: hypogonad, hyperprolactin

Question 2

opioid without known active metabolites in RENAL

Answer 2

fentanyl, methadone, bupenopine

Question 3

How to use Naloxone

Answer 3

• Administer naloxone intravenously or intramuscularly.
• Dilute an ampule of naloxone 400 μg/mL to 10 mL in 0.9% saline.
• Administer 0.5 mL (20 μg) every 2 minutes until the respiratory rate is satisfactory.
• Boluses every 30 to 60 minutes may be required in view of the short duration of action of naloxone (10 to 45 minutes). This is especially important after large doses of slow-release preparations or methadone.
• An infusion of naloxone in a syringe driver may be required.

Question 4

Addiction prevention

Answer 4

• Pain agreement/ contracts
• Random urine drug screening
• Prescribe small qualities
• Frequent visits
• SINGLE pharmacy and Prescriber
• Pill counts: NO replacement, NO Early prescriptoions, NO changes without physician consent

Question 5

Managing non malignant pain

Answer 5

1. Evaluating the patient and establishing the pain “diagnosis”
2. Identifying any curative treatment
3. Tailoring analgesic medications to the individual
4. Maximizing nonpharmacological analgesic interventions
5. Monitoring the patient for response to treatment and modifying the treatment plan accordingly.

Question 6

Nonpharmacological Interventions

Answer 6

1. Anesthetic Procedures
2. Neurosurgical Procedures
3. Physical Treatment
4. Cognitive and behavioral intervention

Question 7

equianalgesic dose

Answer 7

• Frequently derived from opioid-naïve postoperative patients receiving single doses.
• Use a rough clinical guide as substantial inter-individual variation exists.
• INCOMPLETE cross tolerance; A 25%-50% reduction in equianalgesic doses is recommended EXCEPT when rotating to METHADONE, or switching route.
• Some experts recommend 25% dose reduction account for inter-individual variation in first pass clearance.

Question 8

Morphine to methadone Ratio

Answer 8

If morphine is

• Less than 90 mg per day; 4:1
• 90 - 400 mg per day; 5:1.
• Greater than 400 mg per day; 10:1.

Question 9

Morphine 10mg IV equal to

Answer 9

• Morphine 30mg PO
• Hydromorphone 1.5 mg IV
• Hydromorphone 7.5 mg PO

Question 10

How fast can opioids be safely dose escalated?

Answer 10

• Short-acting can be safely dose escalated every 2 hours.
• Sustained release can be escalated every 24 hours. For methadone, levorphanol, or transdermal fentanyl no more frequently than every 72 hours is recommended.

Question 11

By how much, can opioids be safely dose escalated?

Answer 11

• By 25-50% for mild to moderate pain.
• By 50-100% for moderate to severe.
• No analgesia benefit when dose increases are less than 25% above baseline.
• Do NOT increase more than 100% at any one time, irrespective of how many bolus/breakthrough doses have been used.

Question 12

Opioid poorly responsive pain

Answer 12

Neuropathic pain, bone, colic, bladder and rectal tenesmus, headaches, and cutaneous pain

Question 13

Neuroexcitatory Effects of Opioids

Answer 13

• Myoclonus
• Opioid-Induced Hyperalgesia

Question 14

Opioid-Induced Hyperalgesia

Answer 14

• increasing in pain in patients who are receiving increasing doses of opioids and no objective evidence of cancer progression or change in the cause of pain.
• Characterised by diffuse and elicited from ordinarily non-painful stimuli.
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