TCA
Tetracyclic antidepressant (NaSSA, noradrenergic and selective serotoninergic antidepressant) - mirtazapine (remeron)-15mg helps sleep,3omg doesn't. helps with appetite.
mirtazepine can interact with warfarin - less arrhythmias than TCAs
SSRI: escitalopram, fluoxetine, fluvoxamine, sertraline
(inhibits reuptake of serotonin, increase serotonin concentration)
SNRI: Venlafaxine (effexor), duloxetine (cymbalta)
tramadol -interaction with warfarin
Showing posts with label Pain. Show all posts
Showing posts with label Pain. Show all posts
Monday, August 15, 2011
Monday, June 13, 2011
opioids and opioid dependence
A 34 year old, opioid-dependant woman is complaining of severe pain on the day after a first metatarsal osteotomy. The nurses are concerned she is drug-seeking. a. How would you assess this patient? (60%) b. Outline your pain management plan. (40%)(May 2010- Q-11)
1). history
- baseline usage of opioids , dose and route (PO or IV)
- last intake of opioids
-nature of the pain- consistent with surgical site? Nociceptive pain?
2)clinical notes: amount of analgesia given and response to analgesia , any missed doses
3) thorough physical and psychological assessment: vital signs, symptoms of withdrawal
b. Issues of acute pain and chronic dependence, which may also be related to opioid tolerance. Larger doses than expected may be required to treat acute nociceptive pain
Multimodal analgesia involving a multidisciplinary team
long acting opioids should be given to maintain baseline requirements and avoid opioid withdrawal.
alternatives to opioids would be non opioid analgesics such as paracetamol and NSAIDS, which should be given strictly round the clock
give fast acting, long acting opioids eg oxynorm for breakthrough pain
opioid sparing techniques include splinting, ankle blocks etc.
I would avoid giving IM pethidine or other short acting opioids
refer to psychiatry for counselling
regular monitoring
establishing boundaries
commonest drugs of abuse?
1). history
- baseline usage of opioids , dose and route (PO or IV)
- last intake of opioids
-nature of the pain- consistent with surgical site? Nociceptive pain?
2)clinical notes: amount of analgesia given and response to analgesia , any missed doses
3) thorough physical and psychological assessment: vital signs, symptoms of withdrawal
b. Issues of acute pain and chronic dependence, which may also be related to opioid tolerance. Larger doses than expected may be required to treat acute nociceptive pain
Multimodal analgesia involving a multidisciplinary team
long acting opioids should be given to maintain baseline requirements and avoid opioid withdrawal.
alternatives to opioids would be non opioid analgesics such as paracetamol and NSAIDS, which should be given strictly round the clock
give fast acting, long acting opioids eg oxynorm for breakthrough pain
opioid sparing techniques include splinting, ankle blocks etc.
I would avoid giving IM pethidine or other short acting opioids
refer to psychiatry for counselling
regular monitoring
establishing boundaries
commonest drugs of abuse?
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