Choosing an opioid Objective 3: Understand the pharmacology relevant to choosing an opioid for pain treatment in terminally ill patients.
Mild opioids : codeine, hydrocodone, oxycodone. Major opioids : morphine, meperidine, hydromorphone, fentanyl, methadone.
The WHO ladder approach stepped care to pain management. When the second step is initiated, medications for persistent pain are administered on an around-the-clock basis, with additional "as needed" booster doses to control break-through Monticello ky whores.
Step Three: The third step of the ladder is to replace the mild opioid with a more potent opioid such as morphine or hydromorphone. The third step is initiated when, despite treatment with the mild opioid, pain persists or increases.
Top of B. Mild opioids: All are full mu agonists with relatively low analgesic efficacy. All are generally administered as fixed-dose combination products with aspirin or acetaminophen.
When using these products, the toxicity of the non-opioid limits the dose of the opioid that can be administered daily. Codeine most constipating of all opioids 2.
Hydrocodone only available in combination products with aspirin or acetaminophen 3. Oxycodone similar to morphine in potency and duration of action somewhat lower Saint-francis-KS party sex effects GI and CNS effects relatively newly available in U.
This allows it to be used at higher doses, so it can also be considered a "major" opioid. Major opioids: All are full mu agonists with high analgesic efficacy 1. Morphine: considered the "gold standard" for pain relief in terminally ill patients because no narcotic is more effective it has a simple route of metabolism with minimal accumulation of clinically ificant metabolites it is effective orally it can be given by variety of routes of administration sustained release Housewives wants hot sex Blandburg preparation is available 2.
Meperidine Demerol : this is a poor choice for chronic pain therapy because: poor oral absorption short duration of action it has a toxic metabolite normeperidine that can cause tremors and seizures, especially if renal function is impaired.