What analgesics
This presentation is the property of its rightful owner.
Sponsored Links
1 / 26

What Analgesics? PowerPoint PPT Presentation


  • 109 Views
  • Uploaded on
  • Presentation posted in: General

What Analgesics?. Paracetamol – Aspirin Nefopam NSAIDS Opioids Topical – capsaicin, rubifacients , nsaids , Local anaesthetics. Add on’s. Diazepam, methocarbamol. Amitriptylline TENS machine Stretching, massage, physio Osteopathy, Acupuncture Antidepressants. 3.

Download Presentation

What Analgesics?

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


What analgesics

What Analgesics?

  • Paracetamol –

  • Aspirin

  • Nefopam

  • NSAIDS

  • Opioids

  • Topical – capsaicin, rubifacients, nsaids, Local anaesthetics


Add on s

Add on’s

  • Diazepam, methocarbamol.

  • Amitriptylline

  • TENS machine

  • Stretching, massage, physio Osteopathy, Acupuncture

  • Antidepressants


What analgesics

3

WHO's three step ladder to use of analgesic drugs

www.who.int/cancer/palliative/painladder

2

1


Opioids

Opioids


Opioids1

Opioids


Equivalent strengths of transdermal opioids i e don t mix up your fentanyl with your butrans

Equivalent strengths of transdermalopioids(i.e. Don’t mix up your fentanyl with your butrans!)


S e of opiates

S/e of opiates

  • constipation, nausea, somnolence, itching, dizziness, vomiting

  • Tolerance to SE usually occurs within few days,

  • Constipation & itching tend to persist

  • Manage with antiemetics (cyclizine), aperients (movicol), antihistamines

  • Respiratory depression only likely with major changes in dose, formulation or route.

  • Accidental overdose is most likely cause

  • Caution if >1 sedative drug or other disorders of respiratory control ( eg OSA)


Long term adverse effects

Long-term adverse effects

  • Endocrine impairment in both men and women

  • Hypothalamic-pituitary pituitary-adrenal/ gonadal axis suppression leading to amenorrhoea, infertility, reduced libido, infertility, depression, erectile dysfunction.

  • Immunological effects- in animals, effects on antimicrobialresponse and tumour surveillance.

  • Opioid induced hyperalgesia - reduce dose, change preparation

  • Pregnancy & neonatal effects


Stopping strong opioid medication

Stopping strong opioid medication

  • Large differences between individuals in susceptibility to, and severity of, withdrawal syndrome

  • Symptoms last up to 72hrs following reduction/withdrawal.

  • Incremental dose reductions 10% -25% depending on patient response and bear in mind half life of preparation


Recommendations 1

Recommendations 1:

  • Useful analgesia in the short and medium term. No data to support longer term use.

  • Useful in neuropathic pain too.

  • Complete relief of pain is rarely achieved. The goal should be to reduce pain sufficiently to facilitate engagement with rehabilitation and the restoration of useful function. Use as part of a wider management plan to reduce disability and improve QOL.


Recommendations 2

Recommendations 2

  • 80% of patients taking opioids experience at least one adverse effect. Discuss before treatment! DO NOT USE in pregnancy / children and use with caution in Elderly.

  • Resp. depression commoner if elderly/coprescription / comorbidity e.g. OSA.

  • Withdrawl symptoms – yawning, sweating abdo cramps common with abrupt withdrawl even short courses of tramadol.


Recommendations 3

Recommendations 3

  • Educate re long term effects of opioids, particularly in relation to endocrine and immune function. Warn re Steroid induced Hyperalgesia.

  • Do not use as first line

  • Consider carefully the decision to start long term therapy and make arrangements for long-term monitoring and follow-up.

  • Use modified release opioids for long term use


Recommendations 4

Recommendations 4

  • Avoid driving at the start of opioid therapy and following major dose changes. Patients responsibility to advise the DVLA that they are taking opioid medication.

  • Addiction is characterised by impaired control over use, craving and continued use despite harm.


  • Login