Palliative Care Flashcards
What are the non-drug aspects of palliative care?
Self-help and education Psychological support Social support Rehabilitation Spiritual services Bereavement care
How do you convert oral codeine/dihydrocodeine to oral morphine sulphate?
Divide by 10
How do you convert oral tramadol to oral morphine sulphate?
Divide by 10
What is the maximum daily dose of codeine?
240mg
What is the usual dose for codeine?
30-60mg 4hrly
What is the usual does of amitriptyline?
10mg ON working up to 75mg ON
What should you always prescribe with NSAIDs
Omeprazole 20mg OD
What should prescribe alongside opiates?
Metoclopramide 10mg TDS
Senna
What is the PRN dose of morphine if on MST?
1/6th of daily MST dose
How do you convert oral morphine to subcut MST?
Divide by 2
How do you convert oral morphine to subcut Diamorphine?
Divide by 3
What opiate should you use if they have poor renal function?
Oxycodone
How do you convert oral morphine to oral oxycodone?
Divide by 2
How do you convert oral to subcut oxycodone?
Divide by 2
How do you convert oral morphine to subcut oxycodone?
Divide by 4
How do you convert oral morphine to transdermal fentanyl?
Divide by 3.6
Mg -> micrograms
When is oromorph effective?
After 30mins
Up to 4 hours
When in MST (Zomorph) effective?
After 4 hours
Up to 12 hours
What is the typical daily starting dose for morphine-naive patients?
20-30mg
How should morphine dose be titrated?
Achieve stable daily dose with oromorph
Convert this dose to MST
Add in 1/6th PRN
Follow-up in 2wks
Which opiates can be given by syringe pump?
MST
Oxycodone
Diamorphine
How frequently are fentanyl patches applied?
Every 72hrs
What doses of fentanyl patches are available?
12micrograms 25mcg 50mcg 75mcg 100mcg
Need oral morphine PRN as well
How often are Buprenorphine patches applied?
Every 7 days
5, 10, 20mcg
How do you convert oral morphine to buprenorphine?
Divide by 1.7
Mg -> mcg
What is good for skeletal muscle spasms?
Diazepam 2-5mg ON
Which antiemetics may worsen Parkinson Sx?
Metoclopramide
Haloperidol
Levomepromazine
Which antiemetics may be useful in those with Parkinson’s?
Domperidone
Ondansetron
What are the features of intestinal obstruction in advanced cancer?
Nausea post meals
Vomiting undigested food
Dull aching or colicky pain
Distension
What is the differential diagnosis of intestinal obstruction?
Constipation secondary to faecal impaction
What drugs should be avoided with intestinal obstruction?
Metoclopramide
Laxatives if complete obstruction
What drugs may help intestinal obstruction?
Hyoscine butylbromide = antispasmodic
What are some stool-softening laxatives?
Lactulose
Movicol
Docusate
What are some stimulant laxatives?
Senna
Bisacodyl
What is the first line antiemetic in bowel obstruction?
Cyclizine or haloperidol
Cyclizine may be incompatible with Buscopan
What is the first line antiemetic for chemical nausea?
Haloperidol
What is the first line antiemetic for raised ICP
Dexamethasone +/- cyclizine
What are the 4 anticipatory medications in SC?
Morphine 5-10mg/24hr
Haloperidol 500mcg PRN
Hyoscine butybromide 20mg PRN
Midazolam 2-5mg PRN
Remember water for injection
