Families should be included in the care of the patient if they wish. Respiration and circulation should be maintained and naloxone is indicated if coma or bradypnoea are present. Rectal route Morphine is also available for rectal administration as suppositories; alternatively oxycodone hydrochloride suppositories can be obtained on special order. 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. Diamorphine causes drowsiness and mental clouding.
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The most serious hazard of therapy is respiratory depression although circulatory depression is also possible. Transdermal preparations of fentanyl and buprenorphine are available, they are not suitable for acute pain or in syrige whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose.
Metoclopramide hydrochloride has a prokinetic action and is used by sringe for nausea and vomiting associated with gastritis, gastric stasis, and functional bowel obstruction. The equivalent subcutaneous dose of diamorphine hydrochloride is about one-third of the oral dose of morphine.
Nausea and vomiting Nausea and vomiting are common in patients with advanced cancer. Syringe driver rate settings 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. If breakthrough pain occurs give a subcutaneous preferable or intramuscular injection equivalent diamorphnie one-tenth to one-sixth of the xiamorphine hour subcutaneous infusion dose.
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. Breathlessness at rest may be relieved by regular oral morphine in carefully titrated doses. Great caution should be exercised in patients with a known tendency or history of diamorpbine abuse. Its first metabolite, monoacetylmorphine, is more slowly hydrolysed in the blood to be concentrated mainly in skeletal muscle, kidney, lung, liver and spleen.
To minimise the risk of infection no individual subcutaneous infusion solution should be used for longer than 24 hours. A suitable laxative should be prescribed routinely. Fungating tumours Fungating tumours can be treated by regular syringd and antibacterial drugs; systemic treatment with metronidazole is often required to reduce malodour but topical metronidazole is also used.
It is kinder to give an intermittent bolus injection subcutaneously —absorption is smoother so that the risk of adverse effects at peak absorption is avoided an even better method is to use a subcutaneous butterfly needle.
Careful assessment of symptoms and needs of the patient should be undertaken by a multidisciplinary team. It is kinder to give an intermittent bolus injection subcutaneously —absorption is smoother so that the risk of adverse effects at peak absorption is avoided an even better method is to use a subcutaneous butterfly needle.
Care needs to be taken with unconscious ssyringe care patients on fixed dose schedules where their renal function is impaired. Show table of contents Hide table of contents 1. Although some families may at first be thfough of caring for the patient at home, support can be provided by community nursing services, social services, voluntary agencies and hospices together with the general practitioner.
If the patient is already receiving an opioid, oxycodone hydrochloride should be started at a dose equivalent to syirnge current analgesic see below. Risk from concomitant use of sedative medicines such as benzodiazepines or related drugs.
Diamorphine hydrochloride is the preferred opioid since its high solubility thrlugh a large dose to be given in a small volume see under Mixing and Compatibility, below. Convulsions Patients with cerebral tumours or uraemia may be susceptible to convulsions. Diamorphine may be given by the intramuscular, intravenous or subcutaneous routes. Cancer drugs can interact with some other medicines and herbal products. They also check how well your liver and kidneys are working.
A prokinetic antiemetic may be a preferred choice for first-line therapy.
Diamorphine | Cancer in general | Cancer Research UK
Diamorphine hydrochloride is sometimes preferred, because being more soluble, it can be given in a smaller volume. The dose is given either as an immediate-release preparation 4-hourly or as a modified- release preparation hourly, in addition to rescue doses. Midazolam is also used for myoclonus. Diazepam may be helpful for dyspnoea associated with anxiety. 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.
Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic. In particular, chlorpromazine hydrochlorideprochlorperazineand diazepam are contra-indicated as they cause skin reactions at the injection site; to a lesser extent cyclizine and levomepromazine also sometimes cause local irritation.