Prescribing for Pain

Question 1

WHO pain ladder
-3 levels

Answer 1

1st - paracetamol, NSAIDs
2nd - codeine
3rd - morphine

Question 2

Paracetamol
-function
-key SE

Answer 2

Analgesia
Antipyretic

PO/IV - bioavailability similar

Liver metabolism
Liver toxicity if ODs

Question 3

NSAID
-function
-key uses
-considerations

Answer 3

Analgesia
Anti-inflammatory

Only give 1 NSAID at a time - all work in the same way
-inhibit COX => inhibit prostaglandin synthesis

Superficial pain - skin, buccal mucosa, joints, bone

Hx peptic ulceration
GI bleed
High bleed risk
Asthma
Moderate/severe renal impairment
Dehydration
Hypersensitivity to NSAID/aspirin

Question 4

Morphine prescribing
-type
-additional meds to prescribe
-alternative in CKD

Answer 4

Regular morphine - MR
PRN for breakthrough - IR (1/6 - 1/10 of daily dose)

Laxative - prescribe at bedtime
Anti-emetic - cyclizine, ondansetron

Mild-moderate renal impairment (30-90) - oxycodone
Severe renal impairment (U30) - buprenophine, fentanyl