Palliative Care and Oncology Flashcards
What is offered for palliative pain intially?
Unless co-morbidities…
20-30mg MR morphine daily + 5mg breakthrough pain
+ Laxatives
Nausea and drowsiness should be transient
What should be offered as therapy for those with renal impairment?
Mild-mod: Oxycodone
Severe: Buprenorphine, fentanyl, alfentanil
What pain relief is available for bone pain?
Strong opioids
Bisphosphonates
Radiotherapy
How much should you increase an opioid dose?
30-50%
How do you convert between
oral codeine and morphine
Oral tramadol and oral morphine
Divide both instances by 10
How do you convert…
Oral morphine to SC morphine
Oral morphine to SC diamorphine
Oral oxycodone to SC diamorphine
/2
/3
/1.5
How much oral morphine are the following equal to…
TD fentanyl 12ug
TD buprenorphine 10mg
30mg
24mg
If a palliative patient is agitated or confused what do you give
1st line
Alternatives
If in terminal phase
Haloperidol
-promazines
midazolam
Antiemesis for GI related stasis
Metoclopramide (unless prokinesis will worsen eg obstruction)
Domperidone
Antiemesis for chemical nausea (eg chemo)
Correct the cause first
Ondansetron/haloperidol/levomepromazine
Antiemesis for visceral/serosal causes of nausea
Cyclizine, levopromazine
+ Anti-cholinerigcs eg hyoscine
Antiemesis for raised intracranial pressure
Cyclizine for nausea
Dexamethasone can be used
Radiotherapy to reduce mass effect
Antiemesis for vestibular nausea
Cyclizine
Metoclopramide/prochlorperazine if refractory
Antiemesis for anxiety/pain (cortical)
Short acting benzo eg lorazepam
For syringe drivers what is…
Used for respiratory secretions
the choice for pain
the drug that can cause interactions most generally
Hyoscine, glycopyrronium
Diamorphine
Cyclizine
