Pain medications Flashcards
A patient is on 5mg IR morphine every 4h.
How much and how often is his PRN dose
Same dose (5mg) Give 1-2hrly
A patient is on 5mg IR morphine every 4h, and taking PRN morphine 6 times during the day.
What should his new 4h dose be?
Calculate previous 24h dose + PRN
= 56 + 56
= 60mg in 24h
Thus he should get 10mg every 4h
A patient is on 30mg MR morphine every 12h.
How much and how often is his PRN dose
PRN dose is 1/6 to 1/10 of 24h dose
6-10 mg (1/6 to 1/10 of 60mg)
Give 1-2hrly
What drug is used to reverse opiate toxicity
Naloxone
In palliative care, what drug is used for pain/ breathlessness in
- normal kidney function
- reduced kidney function
Normal kidney function
MORPHINE
Reduced kidney function
ALFENTANIL
In palliative care, what drug is used for respiratory secretions in
- normal kidney function
- reduced kidney function
Normal kidney function
HYOSCINE HYDROBROMIDE
Reduced kidney function
HYOSCINE BUTYLBROMIDE
In palliative care, what drug is used for nausea in
- normal kidney function
- reduced kidney function
Normal kidney function
CYCLIZINE
Reduced kidney function
HALOPERIDOL
In palliative care, what drug is used for agitation in
- normal kidney function
- reduced kidney function
for both:
MIDAZOLAM
Contraindications to prescribing paracetamol
- liver failure
2. severe renal impairment (eGFR <30)
Contraindications to prescribing NSAIDs
- Peptic ulcer/ GI bleed
- Liver/ renal impairment
- Clotting disorders
- Hypersensitivity (eg asthma)
- Pregnancy
- Hypovolemia
Increased risk of MI and stroke are associated with which COX enzyme
COX2
Contraindications to prescribing all opioids
- Respiratory depression
- Comatose
- Raised ICP/ head injury
What drugs cannot be given with tramadol?
Why?
SSRI/SNRI
Risk of serotonin syndrome.
Tramadol also blocks serotonin/ norepinephrine reuptake
Which drug is normally given for post-operative pain?
Oxycodone (lower risk of opiate toxicity)
What drugs are given for neuropathic pain? Which are 1st line
Amitryptiline, Gabapentin, Pregabalin, Duloxetine
Amitryptiline and Pregabalin are 1st line
