Insomnia Patients with advanced cancer may not sleep because of discomfort, cramps, night sweats, joint stiffness, or fear. Drug treatment The number of drugs should be as few as possible, for even the taking of medicine may be an effort. An antiepileptic may be added or substituted if pain persists; gabapentin and pregabalin are licensed for neuropathic pain. Muscle spasm The pain of muscle spasm can be helped by a muscle relaxant such as diazepam or baclofen. An antiemetic is usually necessary only for the first 4 or 5 days and therefore combined preparations containing an opioid with an antiemetic are not recommended because they lead to unnecessary antiemetic therapy and associated side-effects when used long-term.
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The table shows approximate equivalent doses of morphine and diamorphine hydrochloride. Haloperidol is used by mouth for most metabolic causes of vomiting e.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
Formulations of transdermal patches are available as hourly, hourly and 7-day patches, for further information see buprenorphine. A suitable laxative should be prescribed routinely. If a patient has previously been receiving an antiepileptic drug or has a primary or secondary cerebral tumour or is at risk of convulsion e.
Raised intracranial pressure Headache due to raised intracranial pressure often responds to a high dose of a corticosteroid, such as dexamethasone and should be given before 6 p. Midazolam syrinte also used for myoclonus. Muscle spasm The pain of muscle spasm can be helped by a muscle relaxant such as diazepam or baclofen.
Bowel colic and excessive respiratory secretions Hyoscine hydrobromide effectively reduces compatkbility secretions and bowel colic and is sedative but occasionally causes paradoxical agitation. Metoclopramide hydrochloride can cause skin reactions. Vitamin K may be useful for the treatment and prevention of bleeding associated with prolonged clotting in liver disease.
If this fails, metoclopramide hydrochloride by mouth or by subcutaneous or intramuscular injection can be added; if this also fails, baclofenor nifedipineor chlorpromazine hydrochloride can be tried. The use of physiological saline sodium chloride 0. Hyoscine hydrobromide effectively reduces respiratory secretions and bowel colic and is sedative but occasionally causes paradoxical agitation. About this Canterbury DHB document An antiepileptic may be added or substituted if pain persists; gabapentin and pregabalin are druge for neuropathic pain.
Syringe Driver Drug Compatibility
Constipation Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic. They therefore have no liability whether in tort including negligence or otherwise for any loss or damage arising out of any reliance on this information.
Bowel colic compatibilityy excessive respiratory secretions Bowel colic and excessive respiratory secretions may be reduced by a subcutaneous injection of hyoscine hydrobromidehyoscine butylbromideor glycopyrronium bromide. If these preparations do not control the pain then morphine is the most useful opioid analgesic. Patients with cerebral tumours or uraemia may be susceptible to convulsions.
Anorexia may be helped by prednisolone or dexamethasone. Nerve blocks or regional anaesthesia techniques including the use of epidural and intrathecal catheters can be considered when pain is localised to a specific area.
Morphine immediate-release 30mg 4-hourly or modified- release mg hourly is usually adequate for most patients; some patients require morphine immediate- release up to mg 4-hourly or modified-release mg hourlyoccasionally more is needed. For the dose by subcutaneous infusion see below. Each patient should be assessed on an individual basis.
Hiccup due to gastric distension may be helped by a preparation incorporating an antacid with an antiflatulent. Increments should be made to the dose, not to the frequency of administration. When oral medication is no longer possible, diazepam given compatibilitt, or phenobarbital by injection is continued as prophylaxis.
Syringe Driver Drug Compatibility | MIMS online
If non-opioid analgesics alone are not sufficient, then an opioid analgesic alone or in combination with a non-opioid analgesic at an adequate dosage, may be helpful in the control of moderate pain.
Continuous subcutaneous infusions Although drugs can usually be administered by mouth to control the symptoms of advanced cancer, the parenteral route may sometimes be necessary.
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 stringe cause of medication errors. Capillary bleeding Capillary bleeding can be treated with tranexamic acid by mouth; treatment is usually discontinued one week after the bleeding has stopped, or, if necessary, it can be continued at a reduced dose.
The first dose of the modified-release preparation is given with, or within 4 hours oc, the last dose of the immediate-release preparation. Analgesics can be divided into three broad classes: Amendments must be authorised in accordance with the documented process.