Use of analgesics in practice part 2 Flashcards
(11 cards)
What is the mechanism of action of NSAIDS
NSAIDs have analgesic, antipyretic, and anti-inflammatory actions. They inhibit COX enzymes, reducing prostaglandin formation. COX-1 inhibition can lead to GI side effects, while COX-2 inhibition provides anti-inflammatory effects.
Give an example of standard NSAIDs
Standard NSAIDs: Nonselective (e.g., ibuprofen, aspirin).
Give an example of COX 2 inhibitors
COX-2 Inhibitors: Lower GI side effects (e.g., celecoxib).
What are common side effects of NSAID’s and what drugs can they be taken with to increase risk
Common side effects include GI issues (bleeding, ulcers), renal impairment (particular when prescribed with other drugs that pose similar risks e.g. ACE inhibitors (ramipril)), worsening of asthma, cardiovascular risks, and severe skin reactions. Monitor blood pressure and U&Es annually for long-term NSAID users.
Patients should be advised to take NSAIDs with food to protect the gastric mucosa.
What are opioids mechanism or action and give examples of weak and strong opioids
Opioids bind to CNS receptors. Weak opioids include tramadol and codeine, while strong opioids include morphine and fentanyl. Transdermal patches are not suitable for opioid-naïve patients or acute pain.
When should codeine not be sold OTC
*Chronic obstructive pulmonary disease (COPD) risk of respiratory depression
*Asthma opioids can aggravate bronchoconstriction as a result of histamine release and increase risk of respiratory depression
*Liver diseases or hepatic impairment
*Renal impairment
*Constipation,risk of paralytic ileus and abdominal distension opioids reduce gastric motility
*Other drugs with risk of respiratory depression and similar side effects (e.g.gabapentin, diazepam)
*History of addiction to opioids or drug misuse
*Conditions associated with increased intracranial pressure (e.g. cerebral cancer
or abscess, or benign intracranial hypertension) or a head injury
*Poor or ultrarapid metabolizers of codeine
poor metabolizers may not
experience analgesia, and ultrarapid metabolizers may experience toxicity.
What are the side effects of opioids
Side effects include nausea, sedation, constipation, respiratory depression, and dependency. Monitor for respiratory depression, especially when combined with other CNS depressants.
What is the policy of opioid use in palliative care
Morphine is the first-line strong opioid. Patients are typically started on regular oral modified-release morphine with rescue doses for breakthrough pain. Regular reviews are essential for dose adjustments.
What is the usual adult dose of otc codeine products
Usual adult dose: 30-60mg every 4 hours, max 240mg daily. No GSL products available. Caution against selling OTC to patients with a history of addiction or respiratory issues. 8mg over 500mg
What are opioid counselling points
Discuss risks of addiction and tolerance.
Make a treatment plan with monitoring.
Advise on side effects e.g. sedation, drowsiness & constipation, respiratory depression and safe storage.
Discuss the potential for overdose and withdrawal symptoms.
Discuss interactions with OTC medicines like gabapentin
Discuss how it can effect driving
What is sumatriptan used for and when should it not be sold
Sumatriptan is a 5HT receptor agonist and effects intracranial receptorscausing vasoconstriction used for migraine treatment, with a maximum of 100mg daily OTC (2 x50mg for previously diagnosed migraine. It should not be sold to patients with a history of cardiovascular issues.nIf a patient does not respond to the initial dose they should not take a second dose for the same attack.
Do not sell OTC sumatriptan if
*Ischaemic heart disease
*Uncontrolled hypertension
*Peripheral vascular disease
*Coronary vasospasm
*Previous cerebrovascular accident
*Previousmyocardial infarction (MI)
*Previous transient ischaemic attack
*Prinzmetal’sangina
