QuestionSBA
QuestionChoice
Stopping strong opioids and NSAIDS simultaneously without additional PRN medication would result in a huge decrease in the pain relief for this patient
34451
b
Stop regular morphine sulphate M/R and ibuprofen
QuestionChoice
Pain medication should be down titrated using the reverse ladder starting with strong opioids followed by weak opioids, NSAIDs and paracetamol. PRN Morphine sulphate can be prescribed as an intermediate step to provide analgesia when required. The patient is currently on a total of 40mg regular Morphine sulphate a day and her pain relief is well controlled with no PRN medication required. To step down her analgesic management, her regular morphine sulphate could be stopped while maintaining her usual PRN dose of morphine sulphate if additional pain relief is required
34450
a
Stop regular morphine sulphate M/R and continue PRN morphine sulphate
QuestionChoice
40mg regular Morphine sulphate is equivalent to 400mg dihydrocodeine. Although decreasing the equivalent dose of dihydrocodeine is appropriate, 250mg is still more than the maximum recommended dose per day (240mg)
34454
e
Substitute morphine sulphate M/R with dihydrocodeine 250mg PO
QuestionChoice
40mg regular Morphine sulphate approximates to buprenorphine 20 micrograms/h transdermal patch. Changing to 70 micrograms/h patch would be unnecessarily stepping up her pain control
34453
d
Substitute morphine sulphate M/R with buprenorphine 70 micrograms/h transdermal patch
QuestionChoice
Similarly, stopping all three steps of the analgesic ladder without additional PRN medication would result in a huge decrease in the pain relief for this patient
34452
c
Stop regular morphine sulphate M/R, ibuprofen and paracetamol
QuestionComment
I understand why the dihydrocodeine option is incorrect but I thought step-down on the WHO pain ladder is a weak opioid... Taking someone's regular morphine and relying on just paracetamol and ibroprofen doesn't sound like a nice idea(?)
37068
User
subscriber
Amnesia Yeast
QuestionComment
Most hospitals advise a slow tapering off/ weaning off the opioids, they say reducing about 10-20mg every 3-5 days until they no longer need it anymore, and this is usually with the help of the GP in the community, esp when patients are discharged.

Personally, it seems irresponsible to just take away her 40mg morphine suddenly and let her rely on just paracetamol and ibuprofen. but I believe the question is assuming that she WILL be using her PRN, hence not a sudden stop in morphine, this being the "tapering" or "weaning off" process. so its not entirely wrong, but also i dont think its entirely right either ( i wont recommend doing this when a doctor)

However, that being said, this the best option out of all the options :D 
40094
User
subscriber
Biopsy Cystic
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2833
Post-operative analgesia
Topic
13
Neurosurgery
6901
Case Presentation:


A 75-year-old woman is recovering in the Orthopedic Ward following a total hip replacement of her left hip 2 days ago. PMH Osteoarthritis, Type 2 Diabetes Mellitus, Hypertension. DH Paracetamol 1g QDS PO, Ibuprofen 400mg TDS PO, Omeprazole 20mg PO OD, Metformin 1g BD PO, Amlodipine 10mg PO OD, Morphine sulphate M/R (MST Continus ®) 20mg BD PO, Morphine sulphate I/R (Oramorph ®) 10mg/5mL PRN.
Her surgery is uncomplicated and her postoperative pain is controlled with her usual analgesia. She has not taken any PRN Oramorph over the past 24 hours.

**On Examination**
HR 75/min and regular

BP 120/75 mmHg

RR 12/min

O2 sats 97% RA

Temp 37oC.

Question:
Select the most appropriate decision option with regard to her pain management based on these data.
a