Palliative care Flashcards
breakthrough morphine should be
1/6 of daily dose
1/6 of daily dose
breakthrough morphine
when prescribing morphine also
prescribe laxative, antiemetic
prescribe laxative, antiemetic when prescribing
opiates
opiates to use in CKD
alfentanil, buprenorphine, fentanyl
alfentanil, buprenorphine, fentanyl to be used in
CKD
metastatic bone pain management
opiates, bisphosphonates, radiotherapy
opiates, bisphosphonates, radiotherapy are uesd for
metastatic bone pain
when increaseing morphine does do so by
30-50%
PO codeine to PO morphine
/10
PO tramadol to PO morphine
/10
/10
PO tramadol or codeine to PO morphine
PO morphine to PO oxycodone
/1.5
PO oxycodone to s/c diamorphine
/1.5
/1.5
PO morphine to PO oxycodone and PO oxycodone to s/c diamorphine
PO morphine to s/c diamorphine
/3
/3
PO morphine to s/c diamorphine
12 microgram fentanyl patch to PO morphine
30 mg
30mg PO morphine to fentanyl patch
12 microgram patch
10 microgram buprenorphine patch to PO morphine
24mg
24mg PO morphine to buprenorphine patch
10 microgram patch
PO morphine to s/c morphine
/2
/2
PO morphine to s/c morphine
syringe driver pros
constant infusion therefore no drug peaks/troughs, able to go home with it, mobile
constant infusion therefore no drug peaks/troughs, able to go home with it, mobile
syringe driver pros
syringe driver cons
not suitable for long term due to site irritation, abscesses, continual need for resiting, only permits short term breaks e.g. for showering
not suitable for long term due to site irritation, abscesses, continual need for resiting, only permits short term breaks e.g. for showering
cons of syringe drivers
prescribing controlled drugs in discharge summaries
write: dose, route, frequency, “please supply dose x N ampules/tablets/mLs”, have to write N in numbers and letters
write: dose, route, frequency, “please supply dose x N ampules/tablets/mLs”, have to write N in numbers and letters
when prescribing controlled drugs
controlled drugs can only be prescribed by
F2 and above
MST
morphine sulphate modified release, for background pain management
oromorph
quick release for breakthrough pain
sevredol
morphine sulphate normal release, tablet form, for breakthrough pain
morphine sulphate normal release, tablet form, for breakthrough pain
sevredol
hiccup management in palliative care
chlorpromazine (first line), haloperidol, gabapentin, dexamethazone (hepatic lesions)
opioid SE
N, drowsiness (transient), constipation (persistent), pruitis, resp depression, dependence
syringe driver N+V
cyclizine, levomepromazine, haloperidol, metoclopramide
syringe driver respiratory secretions
hyoscine hydrobromide
syringe driver bowel colic
hyoscine butylbromide
syringe driver agitation/restlessness
midazolam, haloperidol, levomepromazine
syringe driver pain
diamorphine
hyoscine hydrobromide is used to aleviate
respiratory secretions
hyoscine butylbromide is used to alieviate
bowel colic
diamorphine is the preferred opiate for
syringe drivers
