Palliative Care

Question 1

Which drugs are licensed for intractable hiccups in palliative care?

Answer 1

1st line is simple remedies (sipping ice water, holding breath), peppermint water

Drugs that licensed for intractable hiccups:
Chorpromazine / Levomepromazine + Haloperidol

Question 2

Opioid conversion?

Answer 2

Tramadol, codeine and dihydrocodeine = 10x weaker than oral morphine

IV/SC/IM morphine = x2 stronger than oral morphine
(half the oramorph dose)

IV/SC/IM Diamorphine - x3 stronger than oral morphine
(divide the oramorph dose by 3)

SC/IV/IM Oxycodone = 3x stronger than oral morphine
(10mg pO morphine = 3mg of IV oxycodone)

Oral Oxycodone = 2/3rds of the dose of oral morphine
(10mg PO morphine = 6.6 mg PO oxycodone)

Hydromorphine = x5 stronger than oral morphine
(divide the oramorph dose by 5)

TRANSDERMAL PREPARATIONS:
their strength refers to their dose in mcg/hour

Fentanyl = x3 stronger than oral morphine
(divide the PO morphine/24 hrs dose by 3 then find the nearest strength patch)

Buprenorphine = x2 stronger than oral morphine
(divide the PO morphine / 24 hrs dose by 2 then find the nearest strength patch)

Question 3

Calculating the breakthrough dose of analgesia?

Answer 3

1/6th to 1/10th of the 24 hours dose given PRN at 4-6 hourly intervals

Question 4

Transdermal patches of buprenorphine + fentanyl ?

Answer 4

NOT SUITABLE for ACUTE pain or rapidly changing analgesia requirements because takes a while to titrate to the right dose