Laboratory 5 - Clinical checking of controlled drug (CD) prescriptions.

Question 1

What should be given for breakthrough pain

Answer 1

Breakthrough dose should be 1/10th - 1/6th of daily morphine requirements

Dose can be given every 2-4 hours

Eg. total daily morphine dose is 80mg. 1/10th is 8mg, 1/6th is 13mg. Need to consider appropriate dose, would be 10mg due to strengths that are avaiable.

Question 2

What is the maximum morphine dose

Answer 2

No maximum, titrated up until patient cant tolerate anymore

Question 3

What IR morphine are avaiable?

Answer 3

Severadol, oramorph

Question 4

What cousnseilling should be given with MST morphine

Answer 4

Most likely will cause constipation - need to give a stimulant and a softer.

Cause drowsiness

Nausea and vomiting - need access to an antiemetic for first 7-10 days. Variable, may not happen to everyone.

Dont crush/ chew the tablet - affect formubility

Question 5

What are the three things you should check when handing out an opioid?

Answer 5

• Access to breakthrough pain
• Access to an antiemetic
• Access to a laxative

Question 6

What are the SR morphine forms?

Answer 6

MS contin, MST continus, Zomorph

Question 7

What are the counselling points with fentanyl patches?

Answer 7

• Inform patient to change patch every 3 day
• Switch application site every 72 hours
• Keep area of body dry
• Don’t apply to joints
• Don’t cut the patch
• Don’t touch adhesive part of patch – fentanyl is potent, touching could get the drug onto the skin, patient may touch eye.
• When disposing – don’t touch patch when removing, fold over, wrap in tissue and bin

Question 8

What is a syringe driver?

Answer 8

Used to deliver a steady state of medication over 24 hours.