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Strong Opioids +/- adjuvant therapy - page 17 / 38

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Interactions:

Drug

Effect of interaction

Alcohol

Enhances hypotensive and sedative effects of opioids

Anti-psychotics

Enhances hypotensive and sedative effects of opioids

Anxiolytics and Hypnotics

Increased sedative effect when opioid analgesics given concurrently

Beta Blockers - Esmolol

Morphine increases plasma concentration of esmolol

Cimetidine

Decreases metabolism of opioid analgesics

Domperidone

Morphine antagonises the effect of domperidone on GI activity

Metoclopramide

Opioids antagonise effects of metoclopramide on GI activity

Monitoring:

Monitor respiratory rate and BP

Dose:

Acute pain, by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, 10 mg every 4 hours if necessary (15 mg for heavier well-muscled patients); neonate up to 1 month 150 micrograms/kg; infant 1–12 months 200 micrograms/kg; child 1–5 years 2.5–5 mg; child 6–12 years 5–10 mg

By slow intravenous injection, quarter to half corresponding intramuscular dose

Premedication, by subcutaneous or intramuscular injection, up to 10 mg 60–90 minutes before operation; child, by intramuscular injection, 150 micrograms/kg

Postoperative pain, by subcutaneous or intramuscular injection, 10 mg every 2–4 hours if necessary (15 mg for heavier well-muscled patients); neonate up to 1 month 150 micrograms/kg; infant 1–12 months 200 micrograms/kg; child 1–5 years 2.5–5 mg; child 6–12 years 5–10 mg

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

Patient controlled analgesia (PCA), consult hospital protocols

Myocardial infarction, by slow intravenous injection (2 mg/minute), 10 mg followed by a further 5–10 mg if necessary; elderly or frail patients, reduce dose by half

Acute pulmonary oedema, by slow intravenous injection (2 mg/minute) 5–10 mg

Chronic pain, by mouth or by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, 5–20 mg regularly every 4 hours; dose may be increased according to needs; oral dose should be approx. double corresponding intramuscular dose and approximately triple corresponding intramuscular diamorphine dose; by rectum, as suppositories, 15–30 mg regularly every 4 hours

Diamorphine (Heroin) by Emma Cope

Strong opioid analgesic, twice as potent as morphine due to greater penetration of blood brain barrier. Precursor of Morphine, metabolised to 6 acetylmorphine and then morphine in the body.

Pain perception background

3 stage process:

1. Activation of nociceptors in peripheral tissues

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