Advanced pain management

meds that respond better in nociceptive pain

opiods

meds that respond better in neuropathic pain

TCA’s, anti-epileptics, SNRIs, ketamine

max paracetamol dose per 24 hrs

4g

NSAIDs CI

• last trimester of pregnancy

• severe hepatic, renal, cardiac failure

• history of upper GI bleeding/ perforation linked to NSAID use

• concurrent use with other NSAIDs/ Aspirin at analgesic doses/ anticoagulants

• elderly- be cautious

• also maybe ppl who are iron deficient lol

codene available doses

8mg, 15mg, 30mg, 60mg QDS

max codiene dose per 24 hrs

240mg

codiene and CYP2D6

10% of ppl are poor codiene metabolisers bc of this enzyme deficiency= low morphine

why does codiene cause constipation

reduces peristalsis

which opiod is safe in breast feeding

dihydrocodiene

what is tramadol used for

moderate to severe pain

also has noradrenaline and seratonin effects as well as mu receptor opiod analgesic

tramadol level of addiction

HIGH LEVEL of addicton

when to avoid use of tramadol

uncontrolled epilepsy

acute intoxication with alcohol/hypnotics/analgesics

head injury

MAOIs- as can lead to seratonin syndrome

when to caution tramadol use

SSRIs - citalopram/escitalopram/fluoxetine/paroxetine/seratonin syndrome etc

current or history of mental health disorder / substance abuse

tramadol moa

weak -opioid receptor agonist

what to be cautious of in morphine liquid 10mg/5ml

contains high levels of sugar and 10% alcohol

what is actimorph

schedule 2 CD - for pt whp may struggle to measure out low doses of morphine liquid

when is oxycodone typically used

Used in preference to morphine if the patient has a worsening renal function

If morphine is causing xs sedation, nausea, or hallucinations

DrEaMing

Drinking

Eating

Mobilising

main goals of pain management

at what morphine dose is opiod tolerance more likely to occur

in patients managed on doses of 60mg oral morphine equivelnt (OME) or higher

non pharmacological manegement

physical application

physical activity

distractions

spiritual & psychological