palliative care Flashcards
how do you work out a breakthrough pain dose for morphine?
1/6 of TOTAL morphine dose in one day
what medication can you give for pain if you have mild-moderate kidney disease?
oxycodone
what medication can you give for pain if you have severe kidney disease?
alfentanil
buprenorphine
fentanyl
what treatment options can you consider for pain in cancer with bone metastases?
- strong opioids
- radiotherapy
- bisphosphonates eg alendronate
- denosumab
3) used to treat bone lytic diseases- including osteoporosis, Paget’s disease, and tumor-induced hypercalcemia
what medications can be used if someone presents with confusion or agitation and ruled out acute causes of this?
1st line: haloperidol
2nd line: chlorpromazine, levomepromazine
if terminal stages- subcut midazolam
how do you convert oral morphine to subcutaneous morphine?
divide by 2
oral/2 = subcut dose
eg 10mg PO /2 = 5mg SC
how do you convert oral morphine to oral oxycodone?
divide by 1.5
3mg morphine/1.5 = 2mg oxycodone
how do you convert oral morphine to subcut diamorphine?
divide by 3
oral/3= subcut diamorphine
12mg morphine/3 = 4mg subcut diamorphine
how do you convert from oral oxycodone to subcut diamorphine?
divide by 1.5
PO oxycodone/1.5 = SC diamorphine
3mg PO oxycodone/1.5 = 2mg SC diamorphine
what does 12 microgram transdermal fentanyl patch equate to for morphine?
30mg PO morphine daily
what does 10 microgram transdermal buprenoprhine patch equate to oral morphine?
24mg PO morphine daily
how do you increase the dose of opioids?
increase the next dose by 30-50%
how do you convert from oral codeine to oral morphine?
divide by 10
PO codeine/10 = PO morphine
30 mg codeine/10 = 3mg morphine
how do you convert from oral tramadol to oral morphine?
divide by 10
PO tramadol/10 = PO morphine
30mg tramadol/10 = 3mg morphine
how do you convert from oral morphine to oral oxycodone?
divide by 1.5- 2
PO morphine/1.5 = PO oxycodone
3mg morphine/1.5 = 2mg oxycodone
what are the side effects of opioids?
transient: nausea + drowsiness
persistent: constipation
why is oxycodone sometimes better tolerated than morphine?
oxycodone can cause less sedation, vomiting and pruritis than moprhine
but can cause more constipation
what dose to SIGN guideliens suggest to start someone with advanced progressive disease?
20-30mg MR morphine with 5mg IR morphine for breakthrough pain
how do you treat intractable hiccups in palliative care?
1st: chlorpromazine
haloperidol
gabapentin
dexamethasone if hepatic lesions
when is cyclizine good as 1st line anti-emetic?
intracranial causes/raised ICP
intra-vestibular causes/movement disorders
GI obstruction
when is domperidone good to use as an anti-emetic?
gastro-intestinal pain
dopamine antagonist (blocks dopamine receptors) so increases gastric/intestinal muscle contraction- food moves quicker through tract
(dopamine inhibits gut motility)
when is metoclopramide good to use as an anti-emetic?
acute migraine
chemo or radiotherapy-induced N+V
prokinetic agent
when is ondansetron good to use as an anti-emetic?
prevention and treatment of N+V related to chemotherapy
selective 5-HT3 antagonist
hydroxytryptamine
when is dexamethasone good to use as an anti-emetic?
treatment of nausea, anorexia, spinal cord compression, liver capsule pain
raised ICP in addition to cyclizine
