Syringe Drivers

Question 1

When should a syringe driver be considered in palliative care?

Answer 1

When a patient is unable to take oral medication due to nausea, dysphagia, intestinal obstruction, weakness or coma

Question 2

What are the two main types of syringe drivers in UK?

Answer 2

Graseby blue - the delivery rate given in mm per hour

Graseby green - delivery rate given in mm per 24 hours

Question 3

The majority of drugs are compatible with water for injecting, although some require…

Answer 3

Sodium chloride 0.9%

Such as.. ketamine, ondansetron, actreotide

Question 4

What drugs are commonly used in a syringe driver for nausea and vomiting?

Answer 4

Cyclizine, levomepromazine, haloperidol, metaclopramide

Question 5

What drug is used for respiratory secretions in a syringe driver?

Answer 5

Hyoscine hydrobromide

Question 6

What drug is used for bowel colic in a syringe driver?

Answer 6

Hyoscine butylbromide

Question 7

What drugs can be used for agitation/ restlessness in a syringe driver?

Answer 7

Midazolam, haloperidol, levomepromazine

Question 8

What is used for pain relief in a syringe driver?

Answer 8

Diamorphine is the preferred opioid - more soluble than morphine, so easier to administer in higher doses. It is also compatible with most other drugs that may need to be administered subcutaneously.

BUT in most cases morphine is preferred as most people do not require doses large enough to cause solubility issues

Question 9

Parenteral diamorphine is approximately how many times as potent as oral morphine?

Answer 9

3 times

So TDD of morphine should be divided by 3 to get 24 hour s/c dose of diamorphine

Question 10

What is the oral to s/c potency ratio of morphine?

Answer 10

1:2