The equivalent parenteral dose of morphine subcutaneous, intramuscular, or intravenous is about half of the oral dose. Indications for the parenteral route are: Intractable cough Intractable cough may be relieved by moist inhalations or by regular administration of oral morphine. Many acute hospitals and teaching centres now have consultative, hospital-based teams. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. Drugs with antimuscarinic effects antagonise prokinetic drugs and, if possible, should not be used concurrently. Morphine is also available for rectal administration as suppositories; alternatively oxycodone hydrochloride suppositories can be obtained on special order.
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Drug treatment The number of drugs should be as few as possible, for even the taking of medicine may be an effort.
Patients with advanced cancer may not sleep because of discomfort, cramps, night sweats, joint stiffness, or fear. Morphine immediate-release 30mg 4-hourly or modified- release mg hourly is compatibiliyt adequate for most patients; some patients require morphine immediate- release up to mg 4-hourly or modified-release mg hourlyoccasionally more is needed.
The following are problems that may be encountered with syringe drivers and the action that should be taken:.
Syringe Driver Compatibility Chart
In theory injections dissolved in water for injections are more likely to be associated with pain possibly owing to their hypotonicity. Rectal route Morphine is also available for rectal administration as suppositories; alternatively oxycodone hydrochloride suppositories can be obtained on special order.
The pain of bowel colic may be reduced by loperamide hydrochloride. The equivalent subcutaneous dose of diamorphine hydrochloride is about one-third of deugs oral dose of morphine.
Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic. Midazolam is the benzodiazepine antiepileptic of choice for continuous subcutaneous infusion. Hiccup due to gastric distension may be helped by a preparation incorporating an antacid with an antiflatulent. For the dose by subcutaneous compatibilitg see below. The standard dose of a strong opioid for breakthrough pain is usually one-tenth to one-sixth of the regular hour dose, repeated every 2—4 hours as required up to hourly may be needed if pain is severe or in the last days of life.
Nausea and vomiting Nausea and vomiting are common in patients with advanced cancer. Many patients wish to remain at home with their families.
Syringe Driver Drug Compatibility | MIMS online
Morphine equivalences for transdermal opioid preparations have been approximated to allow comparison with available preparations of oral morphine. Syringe driver rate druge Staff using syringe drivers should be adequately trained and different rate settings should be clearly identified and differentiated ; incorrect use of syringe drivers is a common cause of medication errors.
Dexamethasonespecial care is needed to avoid precipitation of dexamethasone when preparing kn. The family may be reassured by the knowledge that the patient will be admitted to a hospital or hospice if the family cannot cope.
Neuropathic pain Patients with neuropathic pain may benefit from a trial of a tricyclic antidepressant. Benzodiazepines, such as temazepammay be useful. Upward titration of the dose of morphine stops when either the pain is relieved or unacceptable adverse effects occur, after which it is necessary to consider alternative measures.
Prescribers should ensure that they are familiar with the correct use of transdermal preparations, see under buprenorphine and fentanyl inappropriate use has caused fatalities. Anorexia Anorexia may be helped by prednisolone or dexamethasone. The general principle that injections should be given into separate sites and should not be mixed does not apply to the use of syringe drivers in palliative care.
The following hour oral doses of morphine are considered to be approximately equivalent to the buprenorphine and fentanyl patches shown, however when switching due to possible opioid-induced hyperalgesia, reduce the calculated equivalent dose of the new opioid by one-quarter to one-half.
Syringe Driver Drug Compatibility
Hospice care of terminally ill patients has shown the importance of symptom control and psychosocial support of the patient and family. Methadone hydrochloride linctus should be avoided because it has a long duration of action and tends to accumulate.
Once their pain is controlled, patients started on 4-hourly immediate-release morphine can be transferred to the same total hour dose of morphine given as the modified-release drugw for hourly or hourly administration. For the treatment of nausea and vomiting associated with cancer chemotherapy see Cytotoxic drugs. Bowel colic and excessive respiratory secretions Hyoscine hydrobromide effectively reduces respiratory secretions and bowel colic and is sedative but occasionally causes paradoxical agitation.
Patients with cerebral tumours or uraemia may be susceptible to convulsions. Kate Grundy see Who’s Who. Not all types of medication can be used in a subcutaneous infusion. Pain management with opioids Oral route Treatment with morphine is given by mouth as immediate-release or modified-release preparations. Oxycodone hydrochloride can be used in patients who require an opioid but cannot tolerate morphine.