Protocols - Hemorio

AVOID IN CHRONIC SUBJECTS:
Meperidine: the chronic use leads to an accumulation of metabolic that is neurotoxic, and causes delirium
and convulsion.
Partial agonist (e.g.: buprenorphine): has lesser effect at the opioid receptor than the pure agonist and has
a maximum effect.
Agonist-antagonist (nalbufine, pentazocina), they block or are neutral in one kind of opioid receptor while
they activate another receptor; it has a high incidence of psychomimetic effects and may cause abstinence
syndrome.
SPECIFICITIES OF EACH OPIATE:
CODEINE When in association to acetaminophen, the maximum dose is 360 mg/day (6
takes of 60 mg), in order not to overtake the maximum dose of acetaminophen,
TRAMADOL
HYDROCHLORIDE
capsule (50mg)
drops (100mg/ml)
suppository and (100
mg)
ampule (50 and
100mg)
NALBUFINE
HYDROCHLORIDE
ampule 1 and 2ml
(1 ml = 10mg of
nalbufine
hydrochloride)
BUPRENORPHINE
HYDROCHLORIDE
ampule 1ml
(0.3mg of
buprenorphine
hydrochloride)
Sublingual tablet (0.2
mg)
that may be harmful to the renal function.
- It presents an analgesic effect for about 6 to 8 h. By parenteral path, 100 mg
are injected via IM or 100 mg IV, slowly, diluted in a saline solution or
glycolated serum.
- For the maintenance of the effect, dilute 2 ampules of 100 mg of Tramadol
Hydrochloride in 500 ml of glycolated or physiological serum, keeping the
dripping at 10 to 20 drops / minute or at an infusion pump 30 to 60 ml/h.
- It is not a pure agonist, it also presents an analogous antagonist effect to
naloxone. It is not recommended for subjects with oncologic pain that have
used another opioid previously, because it can cause abstinence syndrome.
- It must be prescribed the dosage of 10 mg every 3 or 4 h, by parenteral path.
In children, the dose of 0.1mg/kg, by parenteral path, every 3 or 4 h.
- It presents an agonist and antagonist effect. It is a partial agonist.
- It has a maximum effect above 1.2 mg. It may precipitate the abstinence
syndrome in subjects who use another opioid chronically.
- Usually, the opioid agonists are preferred, such as codeine, morphine,
methadone, fentanil, oxycodone, hydromorphine (not yet AVAILABLE in
Brazil). Its effectiveness is not limited by the maximum effect when we increase
the dosage. In addition, the agonists do not antagonize or reverse the effect of
other agonists if we need to use both drugs, what the partial agonists or the
agonists-antagonists do.
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