PCF4_Cover_MAY.qxp 8/18/11 2:57 PM Page 2 Quick Practice Guides Index With few exceptions, the Quick Practice Guides in PCF are restricted to a maximum of 2 pages in order to facilitate everyday use. Before using them, it is important to study the associated text in order to fully understand their rationale. Page Chapter 1: Gastro-intestinal system Management of death rattle (noisy respiratory secretions) 8 Opioid-induced constipation 38 Bowel management in paraplegia and tetraplegia 40 Chapter 4: Central nervous system Depression 187 Psychostimulants in depressed patients with a short prognosis 209 Management of nausea and vomiting 225 Chapter 5: Analgesics Management of procedure-related pain 379 Use of transdermal buprenorphine 388 Use of transdermal fentanyl patches 398 Use of methadone for cancer pain 422 Chapter 6: Infections Cellulitis in lymphoedema 459 Chapter 16 Management of death rattle (noisy respiratory secretions) repeat 637 Chapter 20 Setting up a McKinley T34 syringe pump for CSCI 673 Setting up a Graseby MS16A or MS26 syringe driver for CSCI 676 Chapter 22 Administration of drugs by enteral feeding tube 700 PCF4 PALLIATIVE CARE FORMULARY This first print-run of PCF4 has been made possible, in part, by Help the Hospices, the leading charity supporting hospice care throughout the United Kingdom. www.helpthehospices.org.uk Published by palliativedrugs.com Ltd. Palliativedrugs.com Ltd Hayward House Study Centre Nottingham University Hospitals NHS Trust, City Campus Nottingham NG5 1PB United Kingdom www.palliativedrugs.com # palliativedrugs.com Ltd 2011 The moral rights of the editors have been asserted. PCF3 2007, reprinted 2008, 2009 PCF2 2002, reprinted 2003 PCF1 1998 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission in writing of palliativedrugs.com Ltd and the copyright owners, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to [email protected] or by ordinary mail to the above address. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ISBN 978-0-9552547-5-8 Typeset by OKS Prepress Services Private Ltd, Chennai, India Printed by Halstan Printing Group, Amersham, UK DISCLAIMER Every effort has been made to ensure the accuracy of this text, and that the best information available has been used. However, palliativedrugs.com Ltd neither represents nor guarantees that the practices described herein will, if followed, ensure safe and effective patient care. The recommendations contained in this book reflect the editors’ judgement regarding the state of general knowledge and practice in the field as of the date of publication. Information in a book of this type can never be all-inclusive, and therefore will not cover every eventuality. Thus, those who use this book must make their own determinations regarding specific safe and appropriate patient-care practices, taking into account the personnel, equipment, and practices available at the hospital or other facility at which they are located. Neither palliativedrugs.com Ltd nor the editors can be held responsible for any liability incurred as a consequence of the use or application of any of the contents of this book. Mention of specific product brands does not imply endorsement. Particularly when prescribing a drug for the first time, a doctor (or other independent prescriber) should study the contents of the manufacturer’s Summary of Product Characteristics (SPC), paying particular attention to indications, contra-indications, cautions, drug interactions, and undesirable effects. PCF4 iii EDITORIAL STAFF Editors-in-Chief Robert Twycross DM Oxon, FRCP London Emeritus Clinical Reader in Palliative Medicine, Oxford University Andrew Wilcock DM Nottm, FRCP London Macmillan Clinical Reader in Palliative Medicine and Medical Oncology, Nottingham University Consultant Physician, Hayward House, Nottingham University Hospitals NHS Trust, City Campus Senior Editor Julie Mortimer BPharm, MRPharmS Malcolm Mortimer Media, Nottingham Editors Sarah Charlesworth BPharm, MRPharmS Specialist Pharmacist, Palliative Care Information and Website Management, Hayward House, Nottingham University Hospitals NHS Trust, City Campus Shelagh French BPharm, MRPharmS, MBA Independent Pharmacist, Nottingham Paul Howard BMedSci BM BS Nottm, MRCP London Consultant in Palliative Medicine, Duchess of Kent House, Berkshire West Primary Care Trust Claire Stark Toller BM BCh Oxon, MA, MRCP London Registrar in Palliative Medicine, Oxford Postgraduate Deanery Editorial Board Andrew Broadbent BMedSc, MB ChB, MHM, FRACP, FAChPM Hammondcare Director of Palliative Care, Northern Sydney, Head of Palliative Care Royal North Shore Hospital, Senior Lecturer University of Sydney, NSW, Australia Rachel Burman MB BS, FRCP, MA Consultant in Palliative Care, King’s College Hospital NHS Foundation Trust, Cicely Saunders Institute, London, UK Sue Burge OBE, DM, FRCP Consultant Dermatologist, Dermatology Department, Churchill Hospital, Oxford, UK Venkata Chaitanya MB BS, MRCP Registrar in Palliative Medicine, East Midlands Deanery (North) Rotation, UK E Joanna Chambers MB BS, FRCP, FRCR Consultant in Palliative Medicine (rtd), Southmead Hospital, North Bristol Trust; former Clinical Advisor in Renal End of Life Care, Richard Bright Renal Unit, Southmead Hospital, Bristol, UK Alpna Chauhan MB ChB, MRCP Consultant in Palliative Medicine, John Eastwood Hospice, Sutton-in-Ashfield, Nottinghamshire, UK iv www.palliativedrugs.com EDITORIAL STAFF Brian Creedon MB BCh BAO, MRCPI, MMedSci Consultant in Palliative Medicine, Waterford Regional Hospital, Waterford, Ireland Vincent Crosby FRCP Consultant in Palliative Medicine, Hayward House Specialist Palliative Care Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK Andrew Davies MSc, MD, FRCP Consultant in Palliative Medicine, St. Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford, UK Mervyn Dean MB ChB, CCFP Palliative Care Physician (rtd), Corner Brook, NL, Canada Rebecca Dunn MB BS Registrar in Dermatology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK Churchill Hospital, Oxford, UK Ruth England MRCP Registrar in Palliative Medicine, East Midlands Healthcare Workforce Deanery (North), UK Marie Fallon MD, FRCP St Columbas Hospice Chair of Palliative Medicine, University of Edinburgh and Edinburgh Cancer Centre, UK Jeff Fry BSc, PhD Associate Professor and Reader in Molecular Toxicology, School of Biomedical Sciences, University of Nottingham Medical School, Nottingham, UK Vanessa Halliday PhD, RD Lecturer in Clinical Nutrition and Dietetics, Division of Nutritional Sciences, University of Nottingham, UK Janet Hardy BSc, MD, FRACP Director, Department of Palliative and Supportive Care, Mater Health Services, Brisbane; Professor of Palliative Medicine, University of Queensland, Australia Miriam Johnson MB ChB, MD, FRCP, MRCGP Senior Lecturer in Palliative Medicine, Hull York Medical School, University of Hull, Hull, UK Paul Keeley MB ChB, FRCP Consultant in Palliative Medicine, Glasgow Royal Infirmary, Glasgow, Scotland, UK Vaughan Keeley PhD, FRCP Consultant in Palliative Medicine, Derby Hospitals NHS Trust, Derby, UK Bruce Kennedy BSc(Pharm), MBA Clinical Pharmacy Specialist Palliative Care, Palliative Care Program, Fraser Health, Surrey, BC, Canada Samuel King BM, MRCP Registrar in Palliative Medicine, Southmead Hospital, Bristol, UK Susie Lapwood MA, BM BCh, MRCGP, DFSRH, DipPallMed Lead Doctor, Helen and Douglas House Hospices for Children & Young Adults, Oxford UK Mark Lee MD, MRCP Consultant in Palliative Medicine, NHS South of Tyne and Wear Community Health Services and St Benedict’s Hospice, Sunderland, UK PCF4 v EDITORIAL STAFF Vivian Lucas MB ChB, MA Medical Director, Garden House Hospice, Letchworth Garden City, UK Michael Lucey MB, BMedSc, MRCPI, MBA Consultant in Palliative Medicine, Milford Hospice, Castletroy, Limerick, Ireland Staffan Lundstrom MD PhD Department of Palliative Medicine, Stockholms Sjukhem Foundation and Karolinska Institute, Stockholm, Sweden Michael Minton BSc, MB BS, FRCP Honorary Consultant in Palliative Medicine, Sir Michael Sobell House, Churchill Hospital, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK Tim Morgan BSc, MB ChB, FRCP, FRCS Macmillan Consultant and Lead Physician in Palliative Medicine, Roxburghe House and Aberdeen Royal Infirmary, NHS Grampian and Honorary Senior Lecturer, Aberdeen University, UK Simon Noble MB BS, FRCP, DipPallMed, PGCE Clinical Senior Lecturer in Palliative Medicine, Cardiff University, UK Eileen Palmer BSc(Biochem), MB ChB, FRCP, DipPallMed, CertMedEd, MSt Consultant in Palliative Medicine, NHS Cumbria and North Cumbria University Hospitals Trust, and Medical Director, Hospice at Home, West Cumbria, UK Rachel Quibell MB BS, MRCGP Consultant in Palliative Medicine, Newcastle upon Tyne Hospitals FT and Marie Curie Hospice, Newcastle, UK Victor Pace FRCP, DipPallMed Consultant in Palliative Medicine, St Christopher’s Hospice, London UK Colette Reid MB ChB, MD, MRCGP Consultant in Palliative Medicine, UHB NHSFT Claud Regnard MB ChB, BMSc, FRCP Consultant in Palliative Care Medicine, St. Oswald’s Hospice and Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK John Shaw PhD Hayward House Study