Palliative Care Flashcards
What are the two options for prescribing morphine?
Regular short acting - good for opioid naive and for working out a tolerance.
Twice daily morphine M/R - more stable pain control and overnight pain control
Explain morphine prescribing for an opioid naive patients
Start by giving 2-5mg immediate release up to four hourly
Explain morphine prescribing in patients on regular morphine
Break through = 1/6th to 1/10th of the 24 hour dose
Modified release morphine - Prescribe 12 hourly with what they have been getting within 24 hours
What are some triggers for opioid toxicity?
rapid dose escalation, renal impairment, sepsis, drug interactions
What are the symptoms of opioid toxicity and what should you do?
Delirium, vivid dreams, persistent sedation, myoclonus, hallucinations. Naloxone only given if resp rate < 8.
Reduce dose by 20/30% of 24 hour dose
What should be prescribed along side opioids?
Laxative always, eg, senna. Antiemetic if nausea persists
What are the opioids of choice for patients with renal disease?
Mild-moderate impairment - Oxycodone
Severe - alfentanil or fentanyl
What should you increase opioids by?
30-50% for the next dose
What is the conversion from oral codeine to oral morphine?
divide by 10.
What is the conversion from oral morphine to oral oxycodone?
Divide by 1.5. Oxycodone has fewer side effects
What is the conversion from oral morphine to subcut/IV morphine?
Divide by 2
What is the conversion from oral morphine to subcut diamorphine?
Divide by 3
What some examples of anti emetics
Metoclopramide/domperidone - used in gastritis or gastric stasis/functional bowel obstruction.
Haloperidole - chemical causes
Cyclizine -raised ICP, vestibular
Broad spectrum - Levomepromazine
What can be used to treat hiccups?
Chlorpromazine
What medications are used to control secretions?
Hyoscine butylbromide (buscupan) or glycopyrronium bromide
