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afya
Opioids
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> NICE 2012 Regular oral modified release with immediate release for breakthrough (better to start with than patch) Start at 20-30mg / day with 5mg for breakthrough always give laxatives as well (constipation persistent SE) nausea usually transient - if persists give antiemetic SIGN 2008 breakthough does should be 1/6 of overall daily dose In CKD use alfentanil, buprenorphine or fentanyl Bone met pain - NSAID, bisphosphantes or DXT better Inc dose when needed by 30-50% each time (guided by breakthrough amt) Codeine or Tramadol dose to morphine - divide by 10 Oxycodone to morphine - multiply by 1.5 (?2) Transdermal fentanyl 12 = Morphine oral 30/day Transdermal Buprenorphine 10 = Morphine oral 24/day Oral morphine to subcut diamorph - divide by 3 Oral oxycodone to subcut diamorph - divide by 1.5 Note Oxycodone causes less sedation, vomiting and pruritis but more constipation cf morphine
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Pain