July 29, 2019 posted by

Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic. Analgesics are more effective in preventing pain than in the relief of established pain; it is important that they are given regularly. The infusion is discontinued when the first oral dose of morphine is given. 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. For the use of midazolam by subcutaneous infusion using a continuous infusion device see below. This has led to the use of portable continuous infusion devices, such as syringe drivers, to give a continuous subcutaneous infusion , which can provide good control of symptoms with little discomfort or inconvenience to the patient.

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Many acute hospitals and teaching centres now have consultative, hospital-based teams. Commpatibility should be appropriate treatment of these problems before hypnotics are used. A prokinetic antiemetic may be a preferred choice for first-line therapy.

Capillary compxtibility 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. Hospice care of terminally ill patients has shown the importance of symptom control and psychosocial support of the patient and family.

During the titration phase the initial dose is based on the previous medication used, the severity of the pain, and other factors compatibiility as presence of renal impairment, increasing age, or frailty. Treatment with morphine is given by mouth as immediate-release or modified-release preparations.

Kate Grundy see Who’s Who. Dexamethasonespecial care is needed to avoid precipitation of dexamethasone when preparing it.


Prescribing in palliative care | Medicines guidance | BNF content published by NICE

Raised intracranial pressure Headache due to raised intracranial drjgs often responds to a high dose of a corticosteroid, such as dexamethasone and should be given before 6 p. The dose is given either as an immediate-release preparation 4-hourly or as a modified- release preparation hourly, in addition to rescue doses.

Not all types of medication can be used in a subcutaneous infusion. Provided that there is evidence of compatibility, selected injections can be mixed in ij drivers. Symptom control Several recommendations in this section involve unlicensed indications or routes. Levomepromazine is licensed to treat pain in palliative care—this use is reserved for distressed patients with severe pain unresponsive to other measures seek specialist advice.

Many patients wish to remain at home with their families.

Increments should be made to the dose, not to the frequency of administration. Review pain management if rescue analgesic is required frequently twice daily or more.

Confusion and restlessness Haloperidol has little sedative effect. The pain of bowel colic may be reduced by loperamide hydrochloride. Glycopyrronium bromide may also be used to treat bowel colic or excessive respiratory secretions.

Pain Pain management in palliative care is focused on achieving control of pain by administering the right drug in the right dose at the right time. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients.

Dry mouth may be relieved by good mouth care and measures such as chewing sugar-free gum, sucking ice or pineapple chunks, or the use of artificial saliva ,dry mouth associated with candidiasis can be treated by oral preparations of nystatin or miconazolealternatively, fluconazole can be given by mouth.

Gastro-intestinal pain The pain of bowel colic may be reduced by loperamide hydrochloride. Oral medication is usually satisfactory unless there is severe nausea and vomiting, dysphagia, weakness, or coma, when parenteral medication may be necessary. Transdermal preparations of fentanyl and buprenorphine are available, they are not suitable for acute pain or in patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose.


Overview Palliative care is syrunge approach that improves the quality of copatibility of patients and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.

Syringe Driver Drug Compatibility

The patient must be monitored closely for efficacy and side-effects, particularly constipation, and nausea and vomiting. Neuropathic pain Patients with neuropathic pain may benefit from a trial of a tricyclic antidepressant. Restlessness and confusion may require treatment with an antipsychotic, e. A corticosteroid, such as dexamethasonemay also be helpful if there is bronchospasm or partial obstruction.

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. erugs

Syringe Driver Compatibility Chart

To minimise the risk of infection no individual subcutaneous infusion solution should be used for longer than 24 hours. A corticosteroid such as dexamethasone may help, temporarily, if there is an obstruction due to tumour.

The first dose of the modified-release preparation is given with, or within 4 hours of, the last dose of the immediate-release preparation. A regular maintenance dose should also be considered, given sgringe daily either by mouth or by subcutaneous injection; alternatively use a continuous infusion device.