PHRM3102 OSCE PMF - Oxycodone

PHRM3102 OSCE PMF Oxycodone +-----------------------------------+-----------------------------------+ | Class | Opioids | +===================================+===================================+ | Indication | Severe acu...

PHRM3102 OSCE PMF Oxycodone +-----------------------------------+-----------------------------------+ | Class | Opioids | +===================================+===================================+ | Indication | Severe acute/chronic pain | +-----------------------------------+-----------------------------------+ | Pregnancy/breastfeeding | Pregnancy | | | | | | - Potential respiratory | | | depression in the newborn and | | | withdrawal effects in | | | neonates | | | | | | Breastfeeding | | | | | | - Occasional dose considered | | | safe | | | | | | - Repeated doses in preterm | | | infant or \< 4 weeks old, | | | monitor ADRs and sedation | +-----------------------------------+-----------------------------------+ | Dose | Acute pain | | | | | | - IV, initially 0.5-2 mg q3-5 | | | mins, dose adjustment needed | | | if patient \>70 | | | | | | - SC | | | | | | \< 40, initially 7.5-12.5 mg | | | q2h | | | | | | 40-60, initially 5-10 mg q2h | | | | | | 60-70, initially 2.5-7.5 mg | | | q2h | | | | | | 70-85, initially 2.5-5 mg | | | every q2h | | | | | | \>85, initially 2-3 mg q2h | | | | | | - PO | | | | | | Adult, conventional tab, | | | initially 5-15 mg q4h | | | | | | Chronic cancer pain | | | | | | - PO, 2.5-5 mg q4-6h | | | | | | - Maintenance | | | | | | PO, half total daily amount | | | q12h | | | | | | SC infusion, half total daily | | | oral amount q24h | | | | | | Chronic non-cancerous pain | | | | | | - PO, CR 5-10 mg BD (start with | | | 5 mg if opioid naïve or | | | elderly), review every 2/52 | | | | | | - Poor response with \>30mg | | | daily -\> taper down slowly | | | and stop | | | | | | Rectal | | | | | | - Adult, rectal 30 mg q6-8h prn | +-----------------------------------+-----------------------------------+ | Side effects | - Sedation | | | | | | - Dizziness | | | | | | - Headache | | | | | | - Orthostatic hypotension | | | | | | - Itch | | | | | | - Dry mouth | | | | | | - Urinary retention | | | | | | - Miosis (excessive | | | constriction of pupil) | | | | | | - Respiratory depression | | | (dose-related) | | | | | | - Constipation | | | | | | - Nausea | | | | | | - Vomiting | | | | | | - Altered mood state (e.g. | | | confusion) | | | | | | - Opioid induced hyperalgesia | | | | | | - Dyspepsia (indigestion) | | | | | | - Flushing (due to histamine | | | release) | | | | | | - Anaphylaxis | | | | | | - Seizure | +-----------------------------------+-----------------------------------+ | Practice points | Renal impairment | | | | | | - CrCl 10-30mL/min, initially ¾ | | | of normal dose | | | | | | - CrCl \70) | | | | | | - SC/IM | | | | | | \85: 2-3 mg q2h | | | | | | - Conventional PO, initially | | | 5-15 mg q4h | | | | | | Acute pain: 1-12 years, \50 mg | | | daily (\>30 mg in elderly), | | | taper down slowly and stop | | | | | | Acute pulmonary oedema | | | | | | - IV 1-5 mg (1 mg for elderly) | | | | | | Renal impariment | | | | | | - CrCl 10-50mL/min, ½ - ¾ daily | | | dose | | | | | | - CrCl \ | | | | | | - The medication may make you | | | feel drowsy and dizzy, so | | | avoid driving and operating | | | machinery until you know you | | | are affected. | | | | | | - Avoid alcohol consumption as | | | the medication may increase | | | its effects. | | | | | | - If have difficulty staying | | | awake or feel very sleepy, | | | stop taking medication and | | | consult your GP ASAP. | | | | | | - Stand up and change posture | | | slowly as it may make feel | | | dizzy if you do those actions | | | too quickly. | | | | | | - Get regular dental checks as | | | long-term use of medication | | | may make your mouth dry which | | | increase the risk of dental | | | caries. | | | | | | - Get adequately hydrated. | | | | | | - Advise the use of laxatives, | | | such as Coloxyl with Senna to | | | prevent constipation | | | | | | - Recommend take-home naloxone | +-----------------------------------+-----------------------------------+ | Drug interaction | - **Rifampicin** increases | | | buprenorphine metabolism. | +-----------------------------------+-----------------------------------+ | Contraindications/complications | - Combination use with benzos | | | and gabapenoids should be | | | avoided due to increased risk | | | of CNS side effects and | | | respiratory depression | | | | | | - Patients with ileus -- oral | | | administration associates | | | with limited drug absorption, | | | parenteral route preferred. | +-----------------------------------+-----------------------------------+ | Monitoring | - Blood pressure | | | | | | - Respiratory function | | | | | | - Regular dental checks | | | | | | - Liver enzyme | | | | | | - Regular fall risk assessment | +-----------------------------------+-----------------------------------+ | Notes | - Peak analgesia expected after | | | | | | Conventional PO liquid: 60 | | | mins | | | | | | SC: 50-90 mins | | | | | | 60 kg, 10 mg tds | | | | | | 30-60 kg, 5 mg tds | | | | | | 20-30 kg, 2.5 mg tds | | | | | | 15-20 kg, 2 mg 2-3 times | | | daily | | | | | | 10-15 kg, 1 mg 2-3 times | | | daily | | | | | | Chemotherapy induced | | | nausea/vomiting | | | | | | - PO/IV 10mg tds (Max 30 mg | | | daily) | | | | | | Gastric stasis | | | | | | - \>20, PO/IV/IM, 5-10 mg tds | | | | | | Intubation of intestine | | | | | | - \> 20, IV 10-20 mg as a | | | single dose | | | | | | Renal impairment | | | | | | - CrCl \