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Increased risk of convulsions with Selective Serotonin Re-uptake Inhibitor (SSRI) or tricyclic antidepressants.

Antiepileptics

Carbamazepine induces the metabolism of tramadol and thus decreases it’s clinical effect and duration of action

Antivirals.

Plasma concentrations of tramadol increased by ritonavir

Reference: “Tramadol” – Pharmacy section of The Mediweb. http://www.themediweb.net/index.htm

Monitoring:

In the postoperative period, the patient should be closely monitored for pain relief as well as for side-effects especially respiratory depression.

Dose:

Oral, 50–100 mg not more often than every 4 hours; total of more than 400 mg daily by mouth not usually required; child not recommended

IM or IV injection/infusion (over 2–3 minutes) 50–100 mg every 4–6 hours.

Postoperative pain relief, 100 mg initially then 50 mg every 10–20 minutes if necessary during first hour to total max. 250 mg (including initial dose) in first hour, then 50–100 mg every 4–6 hours; max. 600 mg daily; child not recommended

WHO Level 3

Morphine by Andrea Norman

The standard against which any new analgesic is assessed

Mode of operation:

Receptors:

Widely distributed throughout the brain

µ receptors

receptors (more important in the periphery)

receptors (contribute to analgesia at spinal level)

G-protein coupled receptors

Inhibit adenylate cyclase thus reducing intracellular cAMP

Promote opening of potassium channels

Inhibit opening of voltage gated calcium channels

Thus reducing neuronal excitability (due to hyperpolarisation of the membrane due to potassium) and reducing transmitter release (due to inhibition of calcium entry) leading to a decrease in transmission of nociceptive stimuli to the Central Nervous System.

Morphine causes a powerful sense of contentment which is an important component of its analgesic effect, since the agitation and anxiety associated with a painful illness or injury are reduced.

Respiratory depression is mediated by µ-receptors – morphine exerts a decrease in the sensitivity of the respiratory centre of the medulla to PCO2.

Morphine increases tone and reduces motility in the GI system resulting in constipation.

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