Nottingham Renal and Transplant Unit

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Nottingham Renal and Transplant Unit"

Transcription

1 Nottingham Renal and Transplant Unit GUIDELINES FOR PRESCRIBING ANTICIPATORY MEDICINES FOR PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE APPROACH END OF LIFE Author: Contact Name and Job Title Directorate & Speciality Date of submission 7 th January 2015 Dr S.D. Roe, Consultant Nephrologist Sr V. Hinton, Renal Palliative Care Nurse Specialist Ian Hogg, Renal Specialist Pharmacist Cancer and Associated Specialities (Renal/Transplant) Explicit definition of patient group to which it applies (e.g. inclusion and exclusion criteria, diagnosis) Patients with advanced chronic kidney disease (estimated glomerular filtration rate < 30 ml/min) approaching end of life who require prescription of anticipatory medicines. Those dying from a life limiting illness such as cancer who develop significant renal impairment. Version 1.0 If this version supersedes another clinical guideline please be explicit about which guideline it replaces including version number. Statement of the evidence base of the guideline has the guideline been peer reviewed by colleagues? Evidence base: (1-6) Evidence level 5 1 NICE Guidance, Royal College Guideline, SIGN (please state which source). 2a 2b 3a 3b meta analysis of randomised controlled trials at least one randomised controlled trial at least one well-designed controlled study without randomisation at least one other type of well-designed quasiexperimental study 4 well designed non-experimental descriptive studies (ie comparative / correlation and case studies) 5 expert committee reports or opinions and / or clinical experiences of respected authorities 6 recommended best practise based on the clinical experience of the guideline developer Produced January Review date January

2 Consultation Process Ratified by: Date: Target audience These guidelines were developed in conjunction with medical and nursing staff within the renal unit. They have been ratified at the Renal Unit Senior Staff Meeting. Renal Unit Senior Staff Meeting July 2014 Medical and nursing staff within the Renal and Transplant Unit; GP s and community staff caring for patients with advanced CKD in the community Review Date: (to be applied by the Integrated Governance Team) A review date of 5 years will be applied by the Trust. Directorates can choose to apply a shorter review date; however this must be managed through Directorate Governance processes. This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date. Audit Plans Percentage of staff trained to use T34 syringe driver Staff feedback of experience using guideline/care bundle Use of renal anticipatory medication and syringe drivers Communication between medical and nursing staff and with patients and their carers regarding end of life decisions and symptom control at end of life Training and implementation The guidelines will be available on both renal wards. The guidelines are also available on the NUH clinical guidelines database. New members of staff will be made aware of the guidelines as part of their induction programme. T34 syringe driver training Ongoing one to one training as required for staff Produced January Review date January

3 Introduction It is recognised that most patients with kidney disease do not always die directly from kidney failure but from other medical problems. However, renal impairment, even if not the primary problem, is an important consideration when considering prescribing drugs in these patients. This is particularly the case for opioids, as metabolites can and do accumulate in renal impairment and may lead to significant toxicity if this is not recognised. These guidelines are designed to optimise the risk / benefit ratio of these drugs. It is important to be aware that the risks of toxicity and side effects increase cumulatively as GFR falls. These guidelines are aimed at controlling symptoms once it is recognised that the patient is dying and in the last days of life. If further information or advice is needed contact the Renal Pharmacist or Renal Palliative Care Team. These guidelines are based on the Guidelines for LCP Drug Prescribing in Advanced Chronic Kidney Disease (published June 2008; Marie Curie Palliative Care Institute, Liverpool). Produced January Review date January

4 Management of Pain Pain Patient in pain Patient s pain is controlled Is patient already taking oral opioids? Is patient already taking oral opioids? Yes No Yes No If patient is already taking strong opioids, Contact the Specialist Palliativ e Care Team for Adv ice, if they are not available then please see conv ersion chart on page 6. Fentanyl 25 micrograms s/c prn If fentanyl is temporarily unav ailable see below * If patient is already taking strong opioids, Contact the Specialist Palliativ e Care Team for Adv ice, if they are not available then please see conv ersion chart on page 6. Fentanyl 25 micrograms s/c prn If fentanyl is temporarily unav ailable see below* If three or more doses are required over 24 hours consider starting a S/C Syringe Driver of Fentanyl Fentanyl micrograms in a syringe driver over 24 hrs, Prn dose should be 1/8 th of the 24 hr dose. EXAMPLE: 100 micrograms/24 hrs give 12.5 micrograms prn, for 200 micrograms/24 hrs give 25 micrograms prn. If three or more doses are required over 24 hours consider starting a S/C Syringe Driver of Fentanyl Fentanyl micrograms in a syringe driver over 24 hrs, Prn dose should be 1/8 th of the 24 hr dose. EXAMPLE: 100 micrograms/24 hrs give 12.5 micrograms prn, for 200 micrograms/24 hrs give 25 micrograms prn. Supporting Information To convert from other strong opioids contact Specialist Palliative Care Team / Pharmacy for further advice & support as needed. *If fentanyl is temporarily unavailable give: Oxycodone 1-2 milligrams S/C prn Or Morphine milligrams S/C PRN Many of the opioid analgesics and their metabolites may accumulate in Renal Failure causing toxicity with myoclonic jerks, profound acidosis and respiratory depression. Morphine and its metabolites are most likely to cause toxicity. Fentanyl and Alfentanil are less likely to cause these problems, as the metabolites are not active. The duration of the effect from Morphine and Oxycodone may last longer than in a patient with normal renal function. (See conversion table on page 5). If symptoms persist contact the Specialist Palliative Care Team. Anticipatory prescribing in this manner will ensure that in the last hours / days of life there is no delay responding to a symptom if it occurs. Produced January Review date January

5 For patients already on Fentanyl or Buprenorphine patches it is usually recommended that the patch is not removed. Continue to change the patch at prescribed intervals. Additional opioid is given, as appropriate, via the syringe pump. Do not forget to calculate the prn opioid dose based on the total 24 hours opioid dose (i.e. patch and syringe pump doses added together). In patients with low egfr it is not imperative to immediately switch opioid if symptoms are well controlled on their current regime. Produced January Review date January

6 OPIOID CONVERSION TABLE Opioid equivalent doses (Note: There is no exact equivalence between opioids therefore starting low and titrating upwards is recommended safe practice) Approximately equivalent opioid doses for PRN ( as required ) ORAL MORPHINE DIAMORPHINE INJECTION MORHINE INJECTION FENTANYL ALFENTANIL INJECTION OXYCODONE INJECTION 4 milligrams orally 1.25 milligrams 2 milligrams 25 micrograms 125 micrograms 1 milligram 8 milligrams orally 2.5 milligrams 4 milligrams 50 micrograms 250 micrograms Note: alfentanil is not ideal for prn use since it has a very short half-life and doses may only last 1-2 hours 2 milligram Note: Do not use these equivalent doses for larger doses without specialist palliative care advice, as the small numbers entailed have been rounded up. Approximately equivalent opioid doses for starting doses in continuous subcutaneous infusions (Starting doses should be based on prior opioid requirements, and titrated upwards according to the amount of subsequent PRN doses required in addition to the continuous infusion there is no upper limit provided the pain is responding well to the opioid, and there are no symptoms or signs of adverse effects or toxicity. Most patients with renal failure require only low doses if the dose is escalating, advice should be sought from the palliative care team) DIAMORPHINE INJECTION MORHINE INJECTION FENTANYL ALFENTANIL INJECTION OXYCODONE INJECTION 5 10 milligrams 8 16 milligrams Do not use diamorphine in continuous infusion because of the high risk of accumulation and adverse effects Do not use morphine in continuous infusion because of the high risk of accumulation and adverse effects micrograms 500 micrograms to 1 milligram 4 8 milligrams Produced January Review date January

7 Management of terminal restlessness and agitation Terminal restlessness & agitation Present Absent MIDAZOLAM 2.5 milligrams S/C prn MIDAZOLAM 2.5 milligrams S/C prn Review the required medication after 24 hrs; if three or more prn doses have been required then consider a S/C syringe driver over 24 hrs (Midazolam 5 10 milligrams S/C). Continue to give prn dosage accordingly Supporting Information If symptoms persist contact the Specialist Palliative Care Team. Anticipatory prescribing in this manner will ensure that in the last few hours / days of life there is no delay in responding to a symptom if it occurs. Produced January Review date January

8 Management of excessive respiratory tract secretions Excessive respiratory tract secretions Present Absent Hyoscine butylbromide 20mg s/c prn Hyoscine butylbromide 20mg s/c prn Continue to give prn accordingly If three or more doses of prn hyoscine butylbromide are required then consider a S/C syringe driver with mgs S/C over 24 hrs Supporting Information If symptoms persist contact the Specialist Palliative Care Team. Anticipatory prescribing in this manner will ensure that in the last few hours / days of life there is no delay in responding to a symptom if it occurs. Hyoscine Hydrobromide is not usually recommended. Produced January Review date January

9 Management of nausea and vomiting Nausea and/or vomiting Present Absent Levomepromazine 6.25 milligrams s/c prn Levomepromazine 6.25 milligrams s/c prn Continue to give prn accordingly Review after 24 hours. If three or more doses of prn levomepromazine are required then consider a S/C syringe driver with 6.25 milligrams S/C over 24 hrs Supporting Information If symptoms persist contact the Specialist Palliative Care Team. Cyclizine is not usually recommended. Haloperidol milligrams S/C prn is a suitable alternative second line drug (if syringe driver is required then consider milligrams S/C in a syringe driver over 24 hours). Anticipatory prescribing in this manner will ensure that in the last few hours / days of life there is no delay in responding to a symptom if it occurs. Produced January Review date January

10 Management of dyspnoea Dyspnoea Present Absent Is patient already taking oral opioids for breathlessness? Yes No Fentanyl 25 micrograms S/C prn If Fentanyl is unavailable: Morphine milligrams S/C prn Or Oxycodone 1 2 milligrams S/C prn If patient is already taking strong opioids, Contact the Specialist Palliative Care Team for advice, if they are not available then please see conversion chart on page 6 Fentanyl 25 micrograms S/C prn If Fentanyl is unavailable: Morphine milligrams S/C prn Or Oxycodone 1 2 milligrams S/C prn If three or more doses are required over 24 hours consider starting a S/C Syringe Driver of Fentanyl Fentanyl micrograms in a syringe driver over 24 hours, prn dose should be 1/8 th of the 24 hour dose EXAMPLE: 100 micrograms / 24 hrs give 12.5 micrograms prn, for 200 micrograms /24 hrs give 25 micrograms prn Supporting Information If symptoms persist contact the Specialist Palliative Care Team. To convert from other strong opioids contact Specialist Palliative Care Team / Pharmacy for further advice & support. If the patient is breathless and anxious consider Midazolam 2.5 milligrams S/C prn. *If Fentanyl is temporarily unavailable give: Oxycodone 1 2 milligrams S/C prn or Morphine 1.25 milligrams S/C prn Many of the opioid analgesics and their metabolites may accumulate in renal failure causing toxicity with myoclonic jerks, profound narcosis and respiratory depression, Morphine and its metabolites are most likely to cause toxicity. Fentanyl and Alfentanil are less likely to cause these problems, as the metabolites are not active. The duration of the Produced January Review date January

11 effect from Morphine and Oxycodone may last longer than in a patient with normal renal function. Produced January Review date January

12 References Bunn R, Ashley A, (eds). The Renal Handbook. Oxford: Racliffe Medical Pres; 2004 Chambers EJ, Germain, M, Brown E, (eds). Supportive Care for the Renal Patient. Oxford. Oxford University Press; 2004 Davison S. Chronic Pain in End Stage Renal disease. Adv chronic Kidney Dis 2005; 12(13): Dean M. Opioids in Renal Failure and Dialysis Patients. J Pain Symptom Manage 2004; 28(5): Department of Health. The National Service Framework for Renal Services Part Two: Acute Renal Failure Chronic Kidney Disease and End of Life. London Humphreys BD, Soiffer RF, Magee CC. Renal Failure associated with cancer and its treatment: An update. J AM Soc Nephrol 2005: 16: Kurella M, Bennett WM, Chertow GM. Analgesia in Patients with End Stage Renal Disease: A Review of Available Evidence. Am J Kidney Dis 2003, 42(2): Mercadante S, Arcuri E. Opioids and Renal Function. J Pain 2004, 5(1): Murtagh F, Addlington-Hall J, Higginson I. The Prevalence of Symptoms in End-Stage Renal Disease: A Systematic Review. Advances in Chronic Kidney Disease. 2007; 14(1): Scholz J, Steinfath M. Clinical Pharmakokinetics of Alfentanil, Fentanyl and Sufentanil. An Update. Clin. Pharmacokinetics. 1996; 31(4): Urch CE, Carr S, Minton O. A retrospective review of the use of alfentanil in a hospital palliative care setting. Palliat Med 2004; 18(6): US Food and Drug Administration [homepage on the internet]. Rockville MD: Details View: Safety Labelling Changes Approved by FDA Centre for Drug Evaluation and Research. [Updated 2006 Jan; accessed 2006 May 11]. Available from Produced January Review date January

GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS

GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS Bristol Palliative Care Collaborative Contact Numbers: Hospital Specialist Palliative Care Teams: Frenchay 0117 340 6692 Southmead 0117 323

More information

END OF LIFE MEDICINES INFORMATION PACK

END OF LIFE MEDICINES INFORMATION PACK END OF LIFE MEDICINES INFORMATION PACK Advice on end of life medication is available from the nursing and medical team at St Nicholas Hospice Care - telephone 01284 766133. Many drugs used in palliative

More information

The Pharmacological Management of Cancer Pain in Adults. Clinical Audit Tool

The Pharmacological Management of Cancer Pain in Adults. Clinical Audit Tool The Pharmacological Management of Cancer Pain in Adults Clinical Audit Tool 2015 This clinical audit tool accompanies the Pharmacological Management of Cancer Pain in Adults NCEC National Clinical Guideline

More information

Use of opioids in Patients with Impaired Renal Function Dr Jane Neerkin, Dr Mary Brennan, Dr Humeira Jamal

Use of opioids in Patients with Impaired Renal Function Dr Jane Neerkin, Dr Mary Brennan, Dr Humeira Jamal Use of opioids in Patients with Impaired Renal Function Dr Jane Neerkin, Dr Mary Brennan, Dr Humeira Jamal Great care is required when prescribing opioids to patients with impaired renal function. Many

More information

Opioid toxicity and alternative opioids. Palliative care fixed resource session

Opioid toxicity and alternative opioids. Palliative care fixed resource session Opioid toxicity and alternative opioids Palliative care fixed resource session Opioid toxicity and alternative opioids - aims Know the symptoms of opioid toxicity Understand which patients are at higher

More information

Community Pharmacists in NHS Rotherham

Community Pharmacists in NHS Rotherham SERVICE LEVEL AGREEMENT TO ENABLE COMMUNITY PHARMACISTS IN NHS ROTHERHAM TO PROVIDE PALLIATIVE CARE DRUGS AS LOCAL ENHANCED SERVICE PREPARED BY: NHS Rotherham CCG Medicines Management Team on behalf of

More information

Pain Control Aims. General principles of pain control. Basic pharmacokinetics. Case history demo. Opioids renal failure John Welsh 8/4/2010

Pain Control Aims. General principles of pain control. Basic pharmacokinetics. Case history demo. Opioids renal failure John Welsh 8/4/2010 Pain Control Aims General principles of pain control Basic pharmacokinetics Case history demo Opioids renal failure John Welsh 8/4/2010 Pain Control Morphine is gold standard treatment for moderate to

More information

Berkshire Healthcare NHS Foundation Trust Becky White CHS Pharmacist April 2013

Berkshire Healthcare NHS Foundation Trust Becky White CHS Pharmacist April 2013 Berkshire Healthcare NHS Foundation Trust Becky White CHS Pharmacist April 2013 Access to palliative care drugs out of hours Agreement set up with local community pharmacy s to hold stock of commonly prescribed

More information

Opioid Conversion Ratios - Guide to Practice 2013

Opioid Conversion Ratios - Guide to Practice 2013 Opioid s - Guide to Practice 2013 Released 1 st October 2013 2013. The EMR PCC grants permission to reproduce parts of this publication for clinical and educational use only, provided that the Eastern

More information

On Demand Availability of Palliative Care Drugs Service

On Demand Availability of Palliative Care Drugs Service On Demand Availability of Palliative Care Drugs Service Locally Enhanced Service Author: Peer Review: Produced For review April 2013 Ruth Buchan, Senior Pharmacist Julie Landale, HoMM NHS Calderdale 4th

More information

Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients

Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients Developed by the Mid Atlantic Renal Coalition and the Kidney End of Life Coalition September 2009 This project was supported,

More information

Guide to the Pharmacological Management of End of Life (Terminal) Symptoms in Residential Aged Care Residents

Guide to the Pharmacological Management of End of Life (Terminal) Symptoms in Residential Aged Care Residents Guide to the Pharmacological Management of End of Life (Terminal) Symptoms in Residential Aged Care Residents Residential Aged Care Palliative Approach Toolkit Guide to the Pharmacological Management of

More information

Service Specification for NHS Community Pharmacy Palliative Care Drugs Stockist Scheme

Service Specification for NHS Community Pharmacy Palliative Care Drugs Stockist Scheme Service Specification for NHS Community Pharmacy Palliative Care Drugs Stockist Scheme 1. This agreement is between NHS England North Midlands (Derbyshire/ Nottinghamshire only) (the Commissioner) Birch

More information

Opioid Conversion Ratios - Guide to Practice 2013 Updated as Version 2 - November 2014

Opioid Conversion Ratios - Guide to Practice 2013 Updated as Version 2 - November 2014 Opioid s - Guide to Practice 2013 Updated as Version 2 - November 2014 2013. The EMR PCC grants permission to reproduce parts of this publication for clinical and educational use only, provided that the

More information

Guidelines for the Use of Naloxone in Palliative Care in Adult Patients

Guidelines for the Use of Naloxone in Palliative Care in Adult Patients Guidelines for the Use of Naloxone in Palliative Care in Adult Patients Date Approved by Network Governance May 2012 Date for Review May 2015 Changes between Version 1 and 2 1. Guideline background 2.

More information

Nurses Self Paced Learning Module on Pain Management

Nurses Self Paced Learning Module on Pain Management Nurses Self Paced Learning Module on Pain Management Dominican Santa Cruz Hospital Santa Cruz, California Developed by: Strategic Planning Committee Dominican Santa Cruz Hospital 1555 Soquel Drive Santa

More information

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy.

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy. Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality A Guideline for the Management of Acute Alcohol Withdrawal

More information

Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling

Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling Patients with a substance misuse history are at increased risk of receiving inadequate

More information

Opioid Conversion Ratios - Guide to Practice 2010

Opioid Conversion Ratios - Guide to Practice 2010 Opioid Conversion Ratios - Guide to Practice 2010 Released December 2010. 2010. The EMR PCC grants permission to reproduce parts of this publication for clinical and educational use only, provided that

More information

Guidelines for the Use of Subcutaneous Medications in Palliative Care

Guidelines for the Use of Subcutaneous Medications in Palliative Care Guidelines for the Use of Subcutaneous Medications in Palliative Care Dec 2009 Review Dec 2011 1 Acknowledgments These guidelines have been adapted for local use with kind permission from NHS Greater Glasgow

More information

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN MANAGEMENT OF CHRONIC NON MALIGNANT PAIN Introduction The Manitoba Prescribing Practices Program (MPPP) recognizes the important role served by physicians in relieving pain and suffering and acknowledges

More information

WITHDRAWAL OF ANALGESIA AND SEDATION

WITHDRAWAL OF ANALGESIA AND SEDATION WITHDRAWAL OF ANALGESIA AND SEDATION Patients receiving analgesia and/or sedation for longer than 5-7 days may suffer withdrawal if these drugs are suddenly stopped. To prevent this happening drug doses

More information

Abstral Prescriber and Pharmacist Guide

Abstral Prescriber and Pharmacist Guide Abstral Prescriber and Pharmacist Guide fentanyl citrate sublingual tablets Introduction The Abstral Prescriber and Pharmacist Guide is designed to support healthcare professionals in the diagnosis of

More information

Policy for the issue of permits to prescribe Schedule 8 poisons

Policy for the issue of permits to prescribe Schedule 8 poisons Policy for the issue of permits to prescribe Schedule 8 poisons May 2011 Introduction The Victorian Drugs, Poisons and Controlled Substances (DPCS) legislation sets out certain circumstances when a medical

More information

Examples of Good Practice Resource Guide

Examples of Good Practice Resource Guide Examples of Good Practice Resource Guide Just in Case Boxes August 2006 Gold Standards Framework Just in Case Boxes Resource Contents 1. Introduction 2. Gold Standards Framework guidance on developing

More information

! # # # %# # & # ( ) +,. / 01 2 3 4 % # )., 0,, 5((/ + 6 0,67 8,+,, + 6,67, 7 6

! # # # %# # & # ( ) +,. / 01 2 3 4 % # )., 0,, 5((/ + 6 0,67 8,+,, + 6,67, 7 6 ! # # # %# # & # ( ) +,. / % # ).,,, ((/ +,7 8,+,, +,7, 7 9 Title : Non-Medical Prescribing in Palliative Care: A Regional Survey. Corresponding Author: Dr Lucy Ziegler l.e.ziegler@leeds.ac.uk Senior Research

More information

Considerations when Using Controlled Substances to Treat Chronic Pain

Considerations when Using Controlled Substances to Treat Chronic Pain Considerations when Using Controlled Substances to Treat Chronic Pain By Mary-Beth F. Plum, Pharm.D. Impact of Chronic Pain Acute pain is the body s response to environmental dangers, and it helps protect

More information

Local Enhanced Service Contract 2014-15 Supply Nene CCG of Drugs for use in Palliative Care by Community Pharmacies in Nene CCG and Corby CCG

Local Enhanced Service Contract 2014-15 Supply Nene CCG of Drugs for use in Palliative Care by Community Pharmacies in Nene CCG and Corby CCG Local Enhanced Service Contract 2014-15 Supply Nene CCG of Drugs for use in Palliative Care by Community Pharmacies in Nene CCG and Corby CCG Designated contact: NHS England Herts & South Midlands Area

More information

CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE

CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Obstetric Early Warning Score Guideline Implementation

More information

Guidelines for the use of Methadone for Adults with Pain in Palliative Care

Guidelines for the use of Methadone for Adults with Pain in Palliative Care Guidelines for the use of Methadone for Adults with Pain in Palliative Care Date Approved by Network Governance October 2012 Date for Review October 2015 Page 1 of 17 1. Scope of the Guideline 1.1 This

More information

Pain management. The WHO analgesic ladder

Pain management. The WHO analgesic ladder Pain management Successful treatment requires an accurate diagnosis of the cause and a rational approach to therapy. Most pains arise by stimulation of nociceptive nerve endings; the characteristics may

More information

Review of Pharmacological Pain Management

Review of Pharmacological Pain Management Review of Pharmacological Pain Management CHAMP Activities are possible with generous support from The Atlantic Philanthropies and The John A. Hartford Foundation The WHO Pain Ladder The World Health Organization

More information

Implementing stock end-of-life medication in UK nursing homes. Kathy Morris, Jo Hockley

Implementing stock end-of-life medication in UK nursing homes. Kathy Morris, Jo Hockley Implementing stock end-of-life medication in UK nursing homes Kathy Morris, Jo Hockley Ab stract Background: In nursing care homes (NCHs), the use of end-of-life care (EoLC) medication has traditionally

More information

Ultram (tramadol), Ultram ER (tramadol extended-release tablets); Conzip (tramadol extended-release capsules), Ultracet (tramadol / acetaminophen)

Ultram (tramadol), Ultram ER (tramadol extended-release tablets); Conzip (tramadol extended-release capsules), Ultracet (tramadol / acetaminophen) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.02.35 Subject: Tramadol Acetaminophen Page: 1 of 8 Last Review Date: September 18, 2015 Tramadol Acetaminophen

More information

Client Summary Palliative Care

Client Summary Palliative Care Client Summary Palliative Care DRAFT 2, March 2014 Gippsland Region Palliative Care Consortium Clinical Practice Group Policy No. Title Keywords Ratified GRPCC Client Summary Palliative Care After-hours,

More information

Medicare Drug Coverage Under Part A, Part B, and Part D

Medicare Drug Coverage Under Part A, Part B, and Part D Medicare Drug Coverage Under Part A, Part B, and Part D Medicare Part A and Part B generally do not cover outpatient prescription drugs, most of which are now covered under Part D. This document and the

More information

Humulin R (U500) insulin: Prescribing Guidance

Humulin R (U500) insulin: Prescribing Guidance Leeds Humulin R (U500) insulin: Prescribing Guidance Amber Drug Level 2 We have started your patient on Humulin R (U500) insulin for the treatment of diabetic patients with marked insulin resistance requiring

More information

Fentanyl patches (Durogesic) for chronic pain

Fentanyl patches (Durogesic) for chronic pain Fentanyl patches (Durogesic) for chronic pain FENT-a-nil Summary Oral morphine is preferred when an opioid is required for severe chronic pain, because of its familiarity, availability and the ease of

More information

The TIRF REMS Access program is a Food and Drug Administration (FDA) required risk management program

The TIRF REMS Access program is a Food and Drug Administration (FDA) required risk management program Subject: Important Drug Warning Announcement of a single shared REMS (Risk Evaluation and Mitigation Strategy) program for all Transmucosal Immediate Release Fentanyl (TIRF) products due to the potential

More information

Pain is a symptom people associate with a malignant illness and is common in non malignant disease.

Pain is a symptom people associate with a malignant illness and is common in non malignant disease. HAWKE S BAY DISTRICT HEALTH BOARD Manual: Clinical Guidelines Manual CRANFORD HOSPICE Doc No: HBDHB/IVTG/139 Issue Date: Review Date: 3 yearly Approved: Cranford Hospice Medical Pain in the Palliative

More information

RESEARCH IN PALLIATIVE CARE: GOALS AND LIMITATIONS

RESEARCH IN PALLIATIVE CARE: GOALS AND LIMITATIONS CAMPUS GROSSHADERN CAMPUS INNENSTADT RESEARCH IN PALLIATIVE CARE: GOALS AND LIMITATIONS Prof. Dr. Claudia Bausewein PhD MSc Research and hospice/palliative care Not new! Emphasis of Cicely Saunders from

More information

OPIOIDS CONVERSION GUIDELINES 2007

OPIOIDS CONVERSION GUIDELINES 2007 Opioid analgesics vary in potency, side effect and pharmacokinetic profile. Therefore the Opioid Conversion Guidelines has been developed to assist when changing opioid drug therapy. When opioid rotating

More information

OUTLINE Supportive care management of the advanced CKD patient

OUTLINE Supportive care management of the advanced CKD patient RENAL SUPPORTIVE CARE. NURSING EXPERIENCE AND PERSPECTIVES Renal Supportive Care Symposium 2013 Elizabeth Josland CNC OUTLINE Supportive care management of the advanced CKD patient Recognise patients who

More information

ABC of palliative care: Principles of palliative care and pain control

ABC of palliative care: Principles of palliative care and pain control Clinical review ABC of palliative care: Principles of palliative care and pain control Bill O'Neill, Marie Fallon Top Introduction Principles of palliative care Principles of managing cancer... Introduction

More information

Recommendations for Alternative Analgesic and Sedative Agents in the Setting of Drug Shortages

Recommendations for Alternative Analgesic and Sedative Agents in the Setting of Drug Shortages Recommendations for Alternative Analgesic and Sedative Agents in the Setting of Drug Shortages Gail Gesin, PharmD* Clinical Phramacist for Trauma Critical Care Carolinas Medical Center Charlotte, North

More information

Using strong painkillers for cancer pain

Using strong painkillers for cancer pain Using strong painkillers for cancer pain This information is an extract from the booklet Controlling cancer pain. You may find the full booklet helpful. We can send you a copy free see page 8. Contents

More information

Collaborative Care Plan for PAIN

Collaborative Care Plan for PAIN 1. Pain Assessment *Patient s own description of pain is the most reliable indicator for pain assessment. Pain intensity to be assessed using the ESAS (Edmonton Symptom Assessment Scale) Use 5 th Vital

More information

Strong opioids (painkillers) in palliative care what you should know

Strong opioids (painkillers) in palliative care what you should know Strong opioids (painkillers) in palliative care what you should know Patient Information Author ID: JG Leaflet Number: PC 006 Version: 1 Name of Leaflet: Strong opioids (painkillers) in palliative care

More information

Tramadol Educational Resource Materials

Tramadol Educational Resource Materials Tramadol Educational Resource Materials Audit Materials November 2013 (Updated August 2014) These educational resource materials have been prepared by a multiprofessional collaborative group, with support

More information

A Guide to pain relief medicines For patients receiving Palliative Care

A Guide to pain relief medicines For patients receiving Palliative Care A Guide to pain relief medicines For patients receiving Palliative Care 1 Which pain medicines are you taking? Contents Page No. Amitriptyline 8 Codeine 9 Co-codamol 10 Co-dydramol 11 Diclofenac (Voltarol

More information

Opioids in Palliative Care- Patient Information Manual

Opioids in Palliative Care- Patient Information Manual Version 2.0 with MST example Introduction The following pages explain what opioids are and what we think you may want to know about them. There is quite a lot of information here, most of it is based on

More information

Alison White Devang Rai Richard Chye

Alison White Devang Rai Richard Chye Ketamine use in hospice patients before and after the sentinel randomised controlled trial of ketamine in cancer pain: A single centre retrospective review Alison White Devang Rai Richard Chye Overview

More information

Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia

Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia Version: 3.0 Ratified by: Medicines Committee Date ratified: 16 th November 2011 Name of originator/author: James

More information

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE INTRODUCTION High dose sublingual buprenorphine (Subutex) tablets are available in the following strengths 0.4 mg, 2 mg, and 8 mg. Suboxone tablets,

More information

Palliative Care Integrated Clinical Pathway

Palliative Care Integrated Clinical Pathway Ward/Unit Date / / PALLIATIVE CARE INTEGRATED CLINICAL PATHWAY FOR E OF LIFE CARE The goal of care: Consideration for the whole person, Maximise quality of life through symptom management, Multidisciplinary

More information

Subcutaneous Medications and Palliative Care: A guide for caregivers

Subcutaneous Medications and Palliative Care: A guide for caregivers Caring Safely at Home palliative care education for caregivers Subcutaneous Medications and Palliative Care: A guide for caregivers Contents Disclaimer 2 Introduction 3 1. FAQ Frequently Asked Questions

More information

Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care

Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care Hull & East Riding Prescribing Committee Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care 1. BACKGROUND Patients who are physically dependent

More information

MODERATE SEDATION RECORD (formerly termed Conscious Sedation)

MODERATE SEDATION RECORD (formerly termed Conscious Sedation) (POLICY #DOC-051) Page 1 of 6 WELLSPAN HEALTH - YORK HOSPITAL NURSING POLICY AND PROCEDURE Dates: Original Issue: September 1998 Annual Review: March 2012 Revised: March 2010 Submitted by: Brenda Artz

More information

West of Scotland Chronic Non Malignant Pain Opioid Prescribing Guideline

West of Scotland Chronic Non Malignant Pain Opioid Prescribing Guideline West of Scotland Chronic Non Malignant Pain Opioid Prescribing Guideline This guidance forms part of the West of Scotland Efficiency and Productivity Workstream, Acute Prescribing Group. Clinicians from

More information

GFR (Glomerular Filtration Rate) A Key to Understanding How Well Your Kidneys Are Working

GFR (Glomerular Filtration Rate) A Key to Understanding How Well Your Kidneys Are Working GFR (Glomerular Filtration Rate) A Key to Understanding How Well Your Kidneys Are Working www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National

More information

Symptom Control and Caring for the Dying Patient: Palliative Care Guidelines 4th Edition

Symptom Control and Caring for the Dying Patient: Palliative Care Guidelines 4th Edition Symptom Control and Caring for the Dying Patient: Palliative Care Guidelines 4th Edition Produced by Kent Palliative Medicine Forum University of Kent May 2010 Midazolam Metoclopramide Levomepromazine

More information

Guidance on competencies for management of Cancer Pain in adults

Guidance on competencies for management of Cancer Pain in adults Guidance on competencies for management of Cancer Pain in adults Endorsed by: Contents Introduction A: Core competencies for practitioners in Pain Medicine B: Competencies for practitioners in Pain Medicine

More information

Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients

Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Jennifer Kuhns, Pharm.D. Pharmacy Practice Resident Children s Hospital of Michigan **The speaker has no actual or potential

More information

URN: Part B - Comfort Care Chart To be completed by attending Nursing and Care Staff A new chart is to be commenced daily

URN: Part B - Comfort Care Chart To be completed by attending Nursing and Care Staff A new chart is to be commenced daily M F I The Brisbane South Palliative Care Collaborative (BSPCC) RAC EoLCP was developed as part of a project funded by the Department of Health and Ageing. The RAC EoLCP is adapted from the Liverpool Care

More information

Palliative Medicine, Pain Management, and Hospice. Devon Neale, MD Assistant Professor Dept of Internal Medicine UNM School of Medicine

Palliative Medicine, Pain Management, and Hospice. Devon Neale, MD Assistant Professor Dept of Internal Medicine UNM School of Medicine Palliative Medicine, Pain Management, and Hospice Devon Neale, MD Assistant Professor Dept of Internal Medicine UNM School of Medicine Pall-i- What??? Objectives: Provide information about Palliative Medicine

More information

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour. Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,

More information

THE USE OF DRUGS BEYOND (OFF-LABEL) AND WITHOUT (UNLICENSED) MARKETING AUTHORIZATION

THE USE OF DRUGS BEYOND (OFF-LABEL) AND WITHOUT (UNLICENSED) MARKETING AUTHORIZATION THE USE OF DRUGS BEYOND (OFF-LABEL) AND WITHOUT (UNLICENSED) MARKETING AUTHORIZATION The use of drugs for off-label purposes is widespread. Surveys suggest that up to 1/4 of all prescriptions in palliative

More information

MELATONIN FOR SLEEP DISORDERS IN CHILDREN AND ADOLESCENTS WITH NEURODEVELOPMENTAL DISORDERS SHARED CARE GUIDELINES

MELATONIN FOR SLEEP DISORDERS IN CHILDREN AND ADOLESCENTS WITH NEURODEVELOPMENTAL DISORDERS SHARED CARE GUIDELINES MELATONIN FOR SLEEP DISORDERS IN CHILDREN AND ADOLESCENTS WITH NEURODEVELOPMENTAL DISORDERS SHARED CARE GUIDELINES Version control: Version Date Main changes/comments V1 4 June 2013 First draft circulated

More information

Medicines reconciliation on admission and discharge from hospital policy April 2013. WHSCT medicines reconciliation policy 1

Medicines reconciliation on admission and discharge from hospital policy April 2013. WHSCT medicines reconciliation policy 1 Medicines reconciliation on admission and discharge from hospital policy April 2013 WHSCT medicines reconciliation policy 1 Policy Title Policy Reference Number Medicines reconciliation on admission and

More information

POAC CLINICAL GUIDELINE

POAC CLINICAL GUIDELINE POAC CLINICAL GUIDELINE Acute Pylonephritis DIAGNOSIS COMPLICATED PYELONEPHRITIS EXCLUSION CRITERIA: Male Known or suspected renal impairment (egfr < 60) Abnormality of renal tract Known or suspected renal

More information

History of Malignant Pain: Treatment with Opioids. Dr. Kathleen M. Foley Pain, Opioids, and Addiction: An Urgent Problem for Doctors and Patients

History of Malignant Pain: Treatment with Opioids. Dr. Kathleen M. Foley Pain, Opioids, and Addiction: An Urgent Problem for Doctors and Patients History of Malignant Pain: Treatment with Opioids Dr. Kathleen M. Foley Pain, Opioids, and Addiction: An Urgent Problem for Doctors and Patients March 5-6, 5 2007 Some of the Questions that Must be Answered

More information

Narcotic drugs used for pain treatment Version 4.3

Narcotic drugs used for pain treatment Version 4.3 Narcotic drugs used for pain treatment Version 4.3 Strategy to restrict the pack sizes or the type of packaging available in public pharmacies. 1. Introduction The document describing the strategy of the

More information

MEDICATION ABUSE IN OLDER ADULTS

MEDICATION ABUSE IN OLDER ADULTS MEDICATION ABUSE IN OLDER ADULTS Clifford Milo Singer, MD Adjunct Professor, University of Maine, Orono ME Chief, Division of Geriatric Mental Health and Neuropsychiatry The Acadia Hospital and Eastern

More information

Palmer MacKie, MD MS Director, Integrative Pain Program, Eskenazi Department of Medicine, IUSOM

Palmer MacKie, MD MS Director, Integrative Pain Program, Eskenazi Department of Medicine, IUSOM Palmer MacKie, MD MS Director, Integrative Pain Program, Eskenazi Department of Medicine, IUSOM Attorney General s Prescription Drug Abuse Task Force Member AIT Laboratories Advisory Board In 2009, 44%

More information

AGS. PAIN MANAGEMENT FOR THE SURGICAL RESIDENT (in 30 min or less)

AGS. PAIN MANAGEMENT FOR THE SURGICAL RESIDENT (in 30 min or less) AGS PAIN MANAGEMENT FOR THE SURGICAL RESIDENT (in 30 min or less) THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. Leading change. Improving care for older adults. CASE PRESENTATION 46-year-old

More information

Survey to Doctors in England End of Life Care Report prepared for The National Audit Office

Survey to Doctors in England End of Life Care Report prepared for The National Audit Office Survey to Doctors in England End of Life Care Report prepared for The National Audit Office 1 2008, medeconnect Table of Contents 1 SUMMARY OF FINDINGS... 3 2 INTRODUCTION... 5 3 RESEARCH OBJECTIVES AND

More information

Chronic Kidney Disease and Diabetes

Chronic Kidney Disease and Diabetes Anyone with diabetes can get kidney disease. Diabetes and high blood pressure are the most common causes of kidney disease, and people often have both. Chronic (long term) kidney disease (CKD) caused by

More information

Implementing Prescribing Guidelines in the Emergency Department. April 16, 2013

Implementing Prescribing Guidelines in the Emergency Department. April 16, 2013 Implementing Prescribing Guidelines in the Emergency Department April 16, 2013 Housekeeping Note: Today s presentation is being recorded and will be provided within 48 hours. Two ways to ask questions

More information

Acute & Chronic Pain Management (requiring opioid analgesics) in Patients Receiving Pharmacotherapy for Opioid Addiction

Acute & Chronic Pain Management (requiring opioid analgesics) in Patients Receiving Pharmacotherapy for Opioid Addiction Acute & Chronic Pain Management (requiring opioid analgesics) in Patients Receiving Pharmacotherapy for Opioid Addiction June 9, 2011 Tufts Health Care Institute Program on Opioid Risk Management Daniel

More information

Best supportive care: Do we know what it is?

Best supportive care: Do we know what it is? Best supportive care: Do we know what it is? Angela Boland Rumona Dickson Barbara Jack James Stevenson Edge Hill University Faculty of Health www.liv.ac.uk/lrig Collaborative partners Liverpool Reviews

More information

Education Program for Prescribers and Pharmacists

Education Program for Prescribers and Pharmacists Transmucosal Immediate Release Fentanyl (TIRF) Products Risk Evaluation and Mitigation Strategy (REMS) Education Program for Prescribers and Pharmacists Products Covered Under This Program Abstral (fentanyl)

More information

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN ISSUE DATE SUBJECT EFFECTIVE DATE MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Opiate Dependence Treatments Pharmacy Service Leesa M. Allen, Deputy Secretary Office of Medical

More information

Morphine Use for At-Home Cancer Patients in Japan

Morphine Use for At-Home Cancer Patients in Japan Tohoku J. Exp. Med., 2004, 204, Morphine 119-123 Use for Cancer Patients in Home Care 119 Morphine Use for At-Home Cancer Patients in Japan KAZUHIKO KOTANI Department of Medicine, Akasaki Public Clinic,

More information

Medication Coordination and Coverage in Hospice

Medication Coordination and Coverage in Hospice Medication Coordination and Coverage in Hospice Alen Voskanian, MD, FAAHPM, AAHIVS Regional Medical Director, VITAS Innovative Hospice Care Assistant Clinical Professor of Medicine, David Geffen School

More information

Good practice for drug calculations

Good practice for drug calculations Good practice for drug calculations A step-by-step guide for nurses, doctors and all other healthcare professionals Pharmacyservices 7048 Drug Cal Guide A6 Update_AW.indd 1 22/07/2014 09:55 2 Contents

More information

Opioid Analgesics. Week 19

Opioid Analgesics. Week 19 Opioid Analgesics Week 19 Analgesic Vocabulary Analgesia Narcotic Opiate Opioid Agonist Antagonist Narcotic Analgesics Controlled substances Opioid analgesics derived from poppy Opiates include morphine,

More information

Care Pathway for the Administration of Intravenous Iron Sucrose (Venofer )

Care Pathway for the Administration of Intravenous Iron Sucrose (Venofer ) Departments of Haematology, Nephrology and Pharmacy Care Pathway for the Administration of Intravenous Iron Sucrose (Venofer ) [Care Pathway Review Date] Guidance for use This Care Pathway is intended

More information

TRANSMUCOSAL IMMEDIATE RELEASE FENTANYL (TIRF) RISK EVALUATION AND MITIGATION STRATEGY (REMS)

TRANSMUCOSAL IMMEDIATE RELEASE FENTANYL (TIRF) RISK EVALUATION AND MITIGATION STRATEGY (REMS) Initial REMS approval: 12/2011 Most recent modification: /2014 TRANSMUCOSAL IMMEDIATE RELEASE FENTANYL (TIRF) RISK EVALUATION AND MITIGATION STRATEGY (REMS) Page 1 of 16 I. GOALS The goals of the TIRF

More information

Cytotoxic and Biotherapies Credentialing Programme Module 5

Cytotoxic and Biotherapies Credentialing Programme Module 5 Cytotoxic and Biotherapies Credentialing Programme Module 5 1. Drug Dose Determination 2. Drug Calculations 3. Role of the Second Checker 4. The Checking Process At the completion of this module the RN

More information

UCB. Certolizumab pegol (CIMZIA ) for the treatment of Rheumatoid Arthritis PATIENT ACCESS SCHEME (PAS) SUBMISSION TO NICE

UCB. Certolizumab pegol (CIMZIA ) for the treatment of Rheumatoid Arthritis PATIENT ACCESS SCHEME (PAS) SUBMISSION TO NICE UCB Certolizumab pegol (CIMZIA ) for the treatment of Rheumatoid Arthritis PATIENT ACCESS SCHEME (PAS) SUBMISSION TO NICE July 23 d 2009 1 Executive summary UCB have proposed a patient access scheme (PAS)

More information

MQAC Rules for the Management of Chronic Non-Cancer Pain

MQAC Rules for the Management of Chronic Non-Cancer Pain MQAC Rules for the Management of Chronic Non-Cancer Pain Effective January 2, 2012 246-919-850 Pain management Intent. These rules govern the use of opioids in the treatment of patients for chronic noncancer

More information

LEFLUNOMIDE (Adults)

LEFLUNOMIDE (Adults) Shared Care Guideline DRUG: Introduction: LEFLUNOMIDE (Adults) Indication: Disease modifying drug for rheumatoid arthritis and psoriatic arthritis Licensing Information: Disease modifying drug for active

More information

POST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics

POST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics POST-TEST University of Wisconsin Hospital & Clinics True/False/Don't Know - Circle the correct answer T F D 1. Changes in vital signs are reliable indicators of pain severity. T F D 2. Because of an underdeveloped

More information

MUSC Opioid Analgesic Comparison Chart

MUSC Opioid Analgesic Comparison Chart MUSC Opioid Analgesic Comparison Chart Approved by the Pharmacy and Therapeutics Committee (February 2006, November 2009, March 2010, December 2011) Prepared by the MUSC Department of Pharmacy Services

More information

Acute pain management for opioid tolerant patients CLASSIFICATION OF OPIOID TOLERANT PATIENTS

Acute pain management for opioid tolerant patients CLASSIFICATION OF OPIOID TOLERANT PATIENTS Update in Anaesthesia Acute pain management for opioid tolerant patients Simon Marshall and Mark Jackson* *Correspondence email: mark.jackson@rdeft.nhs.uk INTRODUCTION Opioid tolerance is usually encountered

More information

Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE)

Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Amber Drug Level 2 Leeds We have started your patient on rivaroxaban for the treatment of provoked VTE (deep

More information

Patient information. Using strong Opioids to control your pain

Patient information. Using strong Opioids to control your pain Patient information Using strong Opioids to control your pain Published: April 2013. Date for review: April 2016 Introduction This leaflet explains what strong opioids (pronounced oh-pee-oyds) e are and

More information

The Medicines Policy. Chapter 2: Standards of Practice PRESCRIBING

The Medicines Policy. Chapter 2: Standards of Practice PRESCRIBING Chapter 2: Standards of Practice PRESCRIBING V2.1 Date: January 2015 CHAPTER 2 Table of Contents 6. Standards and Practice... 3 6.1. Prescribing... 3 6.1.1 Patient-Centred Prescribing... 3 6.1.2 Prescription

More information

Questions about your pain medicines

Questions about your pain medicines Questions about your pain medicines This information is an extract from the booklet Controlling cancer pain. You may find the full booklet helpful. We can send you a free copy see page 6. Contents Common

More information

SELECTED OPIATES TOXICITY A MODERN DAY EPIDEMIC

SELECTED OPIATES TOXICITY A MODERN DAY EPIDEMIC SELECTED OPIATES TOXICITY A MODERN DAY EPIDEMIC Learning Objectives: 1. Identify the names and reasons/circumstances for additional toxicity of SELECTED OPIATES hydromorphone DILAUDID Methadone Fentanyl/DURAGESIC

More information