palliative care Flashcards
choice of opiod in palliative care ?
oral modified-release (MR) or oral immediate-release morphine
WITH
oral immediate-release morphine for breakthrough pain
in preference to transdermal patches
opiod dose in patients with no co morbidities ?
20-30mg of MR a day with 5mg morphine for breakthrough pain
eg 15mg modified-release morphine tablets twice a day with 5mg of oral morphine solution as required
when offering opioids such as morphine what is one of the side effects we should warn patients about ?
nausea is often transient. If it persists then an antiemetic should be offered
drowsiness is usually transient - if it does not settle then adjustment of the dose should be considered
Pruritis
which opiod is preferred in patients with mild to moderate renal disease ?
oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
which opiod is preferred in patients with moderate-severe renal disease ?
alfentanil, buprenorphine and fentanyl are preferred
In addition to strong opioids what may be used to treat metastatic bone pain?
bisphosphonates
and radiotherapy,
and denosumab
conversion of oral codeine into oral morphine ?
Divide by 10
advantage and disadvantage of oxycodone to morphine ?
less sedation, vomiting and pruritis than morphine but more constipation.
conversion of oral morphine to Oral oxycodone
Divide by 1.5-2
conversion of oral morphine to SC morphine ?
Divide by 2
conversion of oral morphine to SC diamorphine ?
Divide by 3
conversion of oral oxycodone to SC diamorphine ?
Divide by 1.5
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indication for syringe driver ?
unable to take oral medication due to nausea, dysphagia, intestinal obstruction, weakness or coma
commonly used drugs for nausea and vomiting ?
cyclizine, levomepromazine, haloperidol, metoclopramide
commonly used drugs for respiratory secretions/bowel colic: ?
hyoscine hydrobromide,
hyoscine butylbromide,
or glycopyrronium bromide.
commonly used drugs for agitation/restlessness ?
midazolam, haloperidol, levomepromazine
which drugs in the syringe driver are compatible with other drugs ?
diamorphine
and cyclizine
cyclizine may precipitate with diamorphine when given at higher doses
discomfort associated with a painful mouth that may occur at the end of life what should we give ?
Benzydamine hydrochloride
Benzydamine is a non-steroidal anti-inflammatory drug which acts topicall
