Notes for: Central nervous systemLast edited [10/12/2021 11:31:41]
‘Safety First: Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness’ recommends that patients at risk of suicide, including all patients with a recent history of self-harm, who are treated with psychotropic drugs should receive modern, less toxic drugs and/or supplies lasting no more than 2 weeks.
Notes for: AnalgesicsLast edited [11/08/2011 13:16:48]
1. It is important that analgesics are given regularly for chronic pain as they are more effective in preventing than relieving pain. Adequate doses of non-opioids given regularly will often make the use of opioids unnecessary.
2. Analgesics have a 'dose ceiling' with regard to efficacy, and the variable side-effect profile up to the maximum useful dose will influence the choice of a particular analgesic.
For advice on pain relief in palliative care see BNF Prescribing in Palliative Care, Joint Formulary Palliative Care Guidelines (chapter 16) and contact the medical staff at:
Mount Edgcumbe Hospice - 01726 65711
St Julia's Hospice - 01736 759070
St Luke's Hospice - 01752 401172
Guidance on other supportive treatments may be obtained from the Pain Relief Clinic at Royal Cornwall Hospital Trust - 01872 252792
Last edited [11/08/2011 13:17:16]Last edited [11/08/2011 13:18:21]Last edited [11/08/2011 13:19:13]Last edited [12/12/2012 16:02:24]
Notes for: Non-Opioid AnalgesicsLast edited [12/12/2012 16:05:55]
1. Avoid compound analgesics if possible, use separate components. The low dose of opioid may be enough to cause constipation without giving a significant additional benefit of pain relief.
2. Reserve dispersible preparations for patients who cannot swallow solid forms. Dispersible tablets are more cost-effective and convenient than syrups. Suppositories are very expensive and other forms should be substituted as soon as convenient.
3. Paracetamol injection is reserved only for patients who cannot be given paracetamol by the oral route nor by the rectal route.
4. MHRA Drug Safety Update (Jul 2010) advises: Vigilance is advised when prescribing and administering intravenous paracetamol 10 mg / mL solution for infusion to ensure that the correct dose is given. For all patients, dose requirement is based on weight. For infants and children who weigh less than 33 kg, the 50 mL vial should be used for administration.
5. Taking 8 tablets per day of soluble paracetamol or soluble co-codamol will increase intake of sodium chloride by 8 g daily. This may be a significant risk in patients with heart failure or hypertension. The Department of Health recommended a maximum daily intake of sodium chloride of 6 g.
6. The CSM has issued a warning regarding tramadol and epilepsy.
7. Enteric coated aspirin has been omitted as there is insufficient evidence of the benefits. The gastro-intestinal side-effects are caused by a systemic action.
8. For more information about pain and analgesia see the Oxford Internet Pain Site at Bandolier, (www.medicine.ox.ac.uk/bandolier)