Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Palliative Care + Oncology > Pain + Syringe Driver > Flashcards

Pain + Syringe Driver Flashcards

1
Q

What should patients be offered when starting Rx if advanced disease

A

Oral morphine modified release (MR) or immediate release
+
Oral immediate release for breakthrough pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What dose should breakthrough pain be

A

1/6 of daily dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is usual starting dose and when would you consider lower dose

A

20-30mg MR a day
15mg BD
Combined with 5mg oral morphine solution for breakthrough

Lower dose if elderly, low BMI, renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is preferred to transdermal

A

Oral MR morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What should be given to all patients on strong opioid

A

Laxative

Constipation is usually persistent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are other SE

A

N+V
Drowsiness
Dry mouth
Usually transient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can you give if not transient

A

Anti-emetic for drowsy

Alter dose if drowsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is 1st line if unable to swallow but not for syringe

A

Morphine / dimorphine SC

Fentanyl transdermal patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should you be caution when prescribing opiotes and what is preferred

A

CKD
Avoid morpine / codeine and precaution with oxycodone in renal impairment

Preferred

  • Fentanyl
  • Buprenorphine
  • Tramadol
  • Alfentanil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you treat metastatic bone pain

A

Strong opioid = most evidence
Biphosphonates
Denosumab
RT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If increasing dose as not enough what should you increase by

A

30-50% every 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is an alternative to morpine and why

A

Dose reduction - 25%
Oxycodone
Less sedation / vomting and itch
Usually causes more constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do you do to dose if going from codeine / tramdaol to morphine

A

Divide dose by 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do you do if going from oral morphine to oxycodone

A

Divide by 2 as oxycodone 2x as strong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If going from oral morphine to SC morphine

A

Divide dose by 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If going from oral morphine to SC diamorphine

A

Divide dose by 3

17
Q

If going from oral oxycodone to SC diamorphine

A

Divide dose by 1.5

18
Q

How is morphine metabolised

A

Liver to active metabolites
Excreted by kidney
Accumulates in kidney failure
Largely unaffected by hepatic failure

19
Q

What does opioid toxicity lead too

A 
Delerium
Altered consciousness / sedation 
Confusion 
Vivid dreams
Hallucination
Myoclonus
Pinpoint pupil + resp depression = late sign
20
Q

What can aggravate opioid toxicity

A

AKI

21
Q

What do you do if only mild morphine toxicity

A

Explain to nurse
Look for renal impairment
Reduce dose
Hydration
Check for malignant hypercalcaemia (reversible cause of delirium)
Consider intracranial bleed / renal failure
Sepsis screen for derlerium
Antagonist is NOT required for mild - only use if life threatening

22
Q

How do you manage pain if opioid toxicity

A

Senior advise
Reduce dose
Consider opioid switch
Add non-opioid analgesia

23
Q

When do you use a syringe driver

A 
Unable to take oral
Nausea
Dysphagia 
Obstruction
Weakness
Coma
24
Q

What do different colours suggest

A 
Blue = mm per hour
Green= mm per 24 hours
25
Q

Most drugs are compatible with water but what drugs require 0.9% saline

A

Ketamine
Octreotide
Odansetron
Ketorolac

26
Q

What is preferred opioid for pain

A

Diamorphine

27
Q

If patient is controlled how do you convert to modified release

A

Add total PRN and divide into 2 12 hour MR

28
Q

What are drugs that are largely septic metabolise so useful in renal failure

A

Fentanyl
Buprenorphine
EXPERT advice needed

29
Q

What can you do for morphine resistant pain

A 
Methadone
Ketamine
Adjuvants such as NSAID, steroid, muscle relacant
Nerve block 
Nerve pain
30
Q

Know drug conversion

A

OK

31
Q

What is Step 1 WHO pain ladder palliative care

A

Non-opiod e.g. paracetamol
WITH weak opioid PRN
+- NSAID with PPI

32
Q

What is Step 2

A

Weak opioid e.g. regular codeine / tramdol
WITH strong opioid PRN
+ PRN anti-emetic and laxative
+_ NSAID with PPI

33
Q

What is step 3

A

Strong opioid e.g. regular morphine
With PRN strong opioid (1/6 of 24 hour dose in 4 hourly interval )
+ PRN anti-emetic and laxative

34
Q

What do you do when pain well controlled

A

Consider switching to sustained release morphine MST

35
Q

What is diamorphine preferred for

A

Injections as rapidly soluble

36
Q

What should you avoid in renal failure

A

Oramorph
Parenteral morphine sulphae
Dimorphine
Oxycodone

37
Q

What is difference between oxycontin and oxynorm

A 
Oxycontin = slow release 12 hour
Oxynorm = immediate release
38
Q

If current pain controlled on oromorph 10mg every 4 hours how do you switch to sustained release

A

MST 30mg BD

+ oromorph 10mg PRN

39
Q

Patient confortable meds but changing to syringe
MST continuous 30mg BD PO
Glycopyrrinium 200mg 6 hourly SC
CYclizine 50mg TDS PO

A

Morphine sulphate 30mg + Glyco 800mg + Cyclicine 150mg in 24ml of water over 24 hours

PRN morphine sulphate SC 5mg max 2 hourly for pain
PRN glyco SC 200mg 4 hourly for secretion
PRN midazolam SC 2.5mg for agitation
PRN levomepromazine SC BD for nausea

Palliative Care + Oncology (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions