Fw: palliativedrugs.com digest 25th June 2010

cal llegir una mica, però es veu com plantejen les enquestes com a forma d'obtenir rendiment económic.

Please help to keep palliativedrugs.com a free-access resource.

2010 sees the 10th anniversary of palliativedrugs.com, which is a noteworthy achievement. We would like to thank members for the support given in helping to make this a valuable resource for professionals and thus patients and families around the world.

Our aim is to keep the site free-access, but finances have been exhausted on more than one occassion, and it would have been impossible to continue without the personal financial support of one of the directors. We have constantly explored ways of securing core funding, and will continue to do so.

Please support the site financially by:

1. Purchasing books via our website bookshop:

http://www.palliativebooks.com/

Palliative Care Formulary (3e) UK edition
Symptom Management in Advanced Cancer (4e)

Hospice and Palliative Care Formulary USA (2e)

**Example sections of each of these books are now available to view in the new Testimonial section of the website**

In 2010 a Canadian version will also be available.

2. Completing a market research survey when invited to do so.

We are very grateful to those members who have done this, it really is a big help.

3. Making a donation or voluntary subscription.

We have never sought direct donations before, but if members or their organisations were so inclined to support our work, it would be most welcome. This could be in the form of a voluntary subscription. Please contact hq@palliativedrugs.com.

With your support, we know that the website will continue to grow and go from strength to strength.

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Calling all members!

This month's survey is SC/IM antibiotics - Do you use this route?

We are reviewing the section in the palliative care formulary on the use of antibiotics for respiratory tract infection in the imminently dying patient (PCF3, page 330). In this section we have examples of the use of antibiotics given as single doses by subcutaneous (SC) or intramuscular (IM) injection. We would value you sharing your experience by completing this short survey (click on link on home page).

Please note that the results of the previous survey, Haloperidol - Do you undertake a baseline ECG? are now available on the website to view.


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Re: difficult pain problem multiple drug sensitivities

author: Doctor Eileen Palmer
role: Doctor
organisation: Hospice at Home West Cumbria, United Kingdom

Thankyou for all these prompt and helpful suggestions (my patient also send her thanks). This is an outstanding resource.

The electronic medicines compendium lists suspect excipients (to use the jargon correctly). Methadone linctus contains both E102 (tartrazine) and E110 (sunset yellow). MST (modified release morphine tablets) 30mg and 60mg both contain E110 (sunshine yellow). Various yellow e-numbers have been linked with migrainous headaches. As I type, she is going to her family doctor to get a prescription for sugar free methadone, which still has E-numbers (caramel E150 and patent blue V E131) but not these particular ones.

See http://emc.medicines.org.uk/

I will let you know how she gets on and if we need to progress to any of the other suggestions.


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ketamine

author: Mrs Elizabeth Tyler
role: Pharmacist
organisation: Boots uk, United Kingdom

I'm working with the newcastle hospices and attempting to update their Standard operating procedures.

I am wondering what guidlines are usually used for the length of time a vial of ketamine can be used safely, after opening.

The manufacturers indicate that a vial can be used for a session in theatre, which could be interpreted as 24 hours. Does any one use it subcutaneously for longer than this?

If the injection is given orally (so a dose can be titrated) can the vial be used for longer than 24 hours, if so has anyone any information as to the stability and saftey.

does anyone have a SOP for ketamine use?

thanks


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availability parenteral dexamethsone

author: Mrs Louise Lee
role: Nurse
organisation: Lincs PCT, United Kingdom

Dear all

Our loacl pharmacists have tried to source parenteral dexamethsone for us but with no success. The wholesalers say there is a manufacturing problem. We have sourced a temporary stock from a local hospital.

I was wondering if anyone else has had problems or knows anymore about the availability ?

Are there any alternatives parenteral products we can use ?

Regards


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paraneoplastic pyrexia?

author: Doctor Christopher Pick
role: Doctor
organisation: Springhill Hospice, United Kingdom

Currently, we have a patient with very advanced mucinous adenocarcinoma on the ward. This lady has a protracted history of pyrexia of unknown origin and was investigated in hospital before coming to the hospice. We have looked for the cause, but to no avail so far. She has bilat nephrostomies, which was the first suspicious cause. Blood cultures, swabs, urine etc have not revealed the source. The temp can reach 39.5 degrees, and seems to spike like an abscess pattern. A repeat CT yesterday showed no such abscess. No foreign travel, malaria or TB contact. Does anyone have experience of a paraneoplastic cause of such high temps? Antibiotic courses have never helped. Not tried anti-fungal yet. Neutrophils are raised.


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