Microsoft word - edwards palliative care nurse practitioner formulary v6

Palliative Care Nurse Practitioner Sydney Adventist Hospital
DRUG FORMULARY for JULIE EDWARDS
Palliative Care Nurse Practitioner
Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 1 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc
The formulary provides for the poisons and restricted substances that may be possessed, used, supplied or prescribed by JULIE EDWARDS as a Nurse
Practitioner under Section 17A of the Poisons and Therapeutic Goods Act 1966 (1) and the Poisons and Therapeutics Goods Regulation 2008 (2) It is the
Nurse Practitioners responsibility to use this formulary in conjunction with the most recent MIMS/MIMS Online (3), Australian Medicines Handbook (4) and
Therapeutic Guidelines: Palliative Care (5).
Any alteration must be submitted to the Chief Nursing and Midwifery Officer (CNMO) NSW for approval. This document is invalid if any alterations or
amendments are made without the approval from the CNMO NSW.
Introduction: The Palliative Care Nurse Practitioner (PCNP):
Has the authority to prescribe, administer, use, supply and possess medications detailed in this PCNP Drug Formulary. Will utilise the most recent and appropriate resources to obtain information on compatibilities of drugs used in continuous subcutaneous infusions. May prescribe end of life medications on the community medication chart prior to discharge, for patients returning home, after consultation with and approval from the patients treating specialist. May convert routes of administration Will document in the medical records whenever a medication change is made. A physical assessment will be included as part of the documentation process. Will seek advice from the palliative care consultant to discuss appropriate management for complex patients and for those patients not responding as expected to treatment changes. Acknowledgement:This Formulary has been adapted from previous work developed by Judith Jacques - Nurse Practitioner Palliative Care - CCLHD;
Pauline Davis – Nurse Practitioner Palliative Care SWSLHD;Debbie White – Nurse Practitioner Palliative Care MNCLHD; Pauline Wilson - Palliative Care
Nurse Practitioner SWCN.
Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 2 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Dosages are in accordance with the Therapeutic Guidelines Palliative Care and Australian Medicines Handbook.
PO = Oral; SL = Sublingual; SC = Subcutaneous; IM = Intramuscular; IV = Intravenous; PR = Per Rectum; TOP = Topical.
Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Analgesia
Non-opioid
Simple analgesic Simple analgesic 1. Mild to moderate pain 2. Osteoarthritis (modified release 665mg) Simple analgesic 1. Mild to moderate pain (when oral route not available) Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 3 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Analgesia
Paracetamol/Codeine Combination Simple Analgesic Mild to moderate pain Paracetamol/Codeine Opioid analgesic Moderate – Severe Pain Opioid Analgesic Moderate – severe breakthrough pain Various strengths Opioid Analgesic Transdermal Patch Patient education on placement and changing of patch. Various strengths Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 4 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Opioid Analgesic 2. Breakthrough pain Opioid Analgesic Sustained release tablet Opioid Analgesic 2. Breakthrough pain 3.Pain management; end of life care Opioid Analgesic 1. Moderate to severe pain (Immediate Release) 2. Breakthrough pain Opioid Analgesic 1. Moderate to severe pain (Sustained Release) Tablet / Granules Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 5 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Morphine Sulphate Opioid Analgesic 1.Moderate to severe pain 2. Breakthrough pain Morphine Tartrate Injection Opioid Analgesic 1. Moderate to severe pain 2. Breakthrough pain Opioid Analgesic 1. Painful wound Infused hydrogel 2. Painful pressure area Opioid Analgesic 1. Moderate to severe pain IR (immediate release) 2. Breakthrough pain Tablet / capsule/ liquid Various strengths Opioid Analgesic Moderate to severe pain SR (sustained release) Various strengths Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 6 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Oxycodone hydrochloride Opioid Analgesic Moderate to severe pain and naloxone hydrochloride dehydrate (Targin) Various strengths Opioid Antagonist
Opioid Antagonist Reversal of opioid overdose; opioid induced respiratory S4 depression: respirations < 8 min NB: Before use consider other causes of sedation or delirium (eg: sepsis) (American Pain Society) Oral/oesophageal candidiasis Systemic candidiasis Miconazole 20mg/ ml Oropharyngeal candidiasis Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 7 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Nystatin 100,000 units/ml Oral / oesophageal candidiasis Sodium Bicarbonate Oral candidiasis Sodium Hyaluronate Gel oral lesions, oral mucositis/stomatitis Vulvovaginal candidiasis Fungal infections, dermatitis Hydrocortisone 1% Metronidazole Gel Malodorous malignant wounds Exacerbation chronic bronchitis; pneumonia; sinusitis Capsule, suspension Amoxycillin with Clavulanic PO URTI; Pneumonia, sinusitis, Tablet; suspension Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 8 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Staphylococcal and streptococcal infection in people S4 with mild – moderate penicillin allergy Capsule; suspension Moderate Spectrum Systemic management of malignant malodorous S4 wounds Tablet / suspension Upper and lower respiratory tract infection Acute uncomplicated urinary tract infection. 1. Patients not responding or unlikely to respond to S4 Hyoscine; for management of respiratory secretions in the terminal phase. 2. Management of respiratory secretions in conscious and alert patients. 3. Management of drooling in MND patients Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 9 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
HyoscineButylbromide Antispasmodic Anticholinergic 1. Management of respiratory secretions in the S4 conscious patient. 2. Management of painful colic in malignant bowel 3. Reduction of gastric secretions HyoscineHydrobromide Management of terminal respiratory secretions Diphenoxylate 2.5 mg Atropine Sulphate 25mcg Antiemetics
Nausea and Vomiting Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 10 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Nausea and vomiting Tablet / Injection Nausea and vomiting Nausea and vomiting Tablet / Injection Anticipatory Nausea and vomiting Antipsychotic, antiemetic 1. Nausea and Vomiting 2. Terminal agitation 1. Nausea and vomiting Tablet / Injection 2. Persistent hiccups Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 11 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Prochlorperazine Nausea and vomiting Tablet / Suppositories 2. Nausea and vomiting Steroidal
1. Pain associated with tumour related oedema 2. Cerebral Oedema 3. Spinal cord compression 4. Superior vena cava obstruction 5. Acute airways obstruction / dyspnoea 6. Malignancy related gastrointestinal obstruction 7. Appetite stimulant and feeling of well being Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 12 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
1. Airways obstruction / dyspnoea 2. Inflammatory disease 3. Appetite stimulate Anti-inflammatory Non
steroidal
Non-steroidal anti-inflammatory Selective COX-2 Inhibitor nausea and vomiting Non-steroidal anti-inflammatory Non-steroidal anti-inflammatory Non-steroidal anti-inflammatory 2. Co-analgesic. Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 13 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Non-steroidal anti-inflammatory Always cover with PPI. Avoid if renal impairment, peptic ulcer, oesophagitis, GORD Non-steroidal anti-inflammatory Non-steroidal anti-inflammatory Pain – co-analgesic Related to inflammation, bony pain Tablet / Injection Hyoscinebutylbromide Antispasmodic and motility agent Colic related to bowel obstruction Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 14 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Hyoscinebutylbromide Antispasmodic and motility agent Colic related to bowel obstruction Anxiolytics
Anxiety or panic associated with dyspnoea Anticipatory nausea Liquid/ injectable 3. Seizure – prophylactic and acute treatment 4. Terminal agitation 2. Pain associated with skeletal muscle spasm Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 15 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
1. Anxiety or panic associated with dyspnoea 2. Agitation related to delirium not responding to Haloperidol alone 1. Terminal restlessness 4. Agitation related to delirium 5. Sudden catastrophic event Laxatives
Always prescribed with Opioids
Prophylaxis and Treatment of Constipation
Soft faeces on rectal examination not responding to oral laxatives Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 16 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Docusate + sennoside B PO Softener+ stimulant (Coloxyl with Senna) Tablet Hard faeces on rectal examination Macrogol 3350, Potassium PO Polyethylene glycol 2. Faecal Impaction (Movicol) Powder 2. Faecal impaction Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 17 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Methylnaltrexone Opioid induced constipation that has not responded to S4 other laxatives citrate 450mg, sodium lauryl sulfoacetate 2. Faecal impaction Sodium Phosphate Constipation unresponsive to other treatments (Fleet ready-to-use enema) Neuropathic Agents
1. Refractory neuropathic pain 2. Uraemic pruritus 2° to renal failure 3. Restless legs syndrome 2° to renal failure Neuropathic Pain Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 18 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Neuropathic pain Sodium Valproate Neuropathic Pain Protein-pump inhibitors
Proton Pump Inhibitor 1. Gastro-oesophageal reflux disease Tablet/ Injection 2. Protection from gastrointestinal irritation from anti-inflammatory medication Proton Pump Inhibitor 1. Gastro-oesophageal reflux disease Tablet/ Injection 2. Protection from gastrointestinal irritation from anti- inflammatory medication Proton Pump Inhibitor 1. Gastro-oesophageal reflux disease Tablet/ Injection 2. Protection from gastrointestinal irritation from anti-inflammatory medication Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 19 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Drug (Generic name)
Therapeutic Class
Clinical Presentation
Schedule
Skeletal muscle relaxant 1.Pain associated with skeletal muscle spasm – S4 particularly in MND Normal Saline 0.9% 2. Comfort measures Normal Saline 0.9% 2. Physiological K+ replacement Dyspnoea, breathlessness Antifibrinolytic 1. Profuse bleeding from malignant wound 2. Haemoptysis; vaginal or rectal bleeding secondary to local tumour invasion Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 20 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc 1. Patients in the terminal phase of their disease will have the reduced ability or inability to swallow medications. The Palliative Care Nurse Practitioner will reduce or cease oral medications and change to an alternate route as appropriate. This process is undertaken in an informative, collaborative manner with the patient, family, carers and the treating Medical Practitioner(s). The same approach will also be taken for the cessation of artificial nutrition and/or hydration. References:
1. Poisons and Therapeutic Goods Act (1966) Section 17A http://www.austlii.edu.au/au/legis/nsw/consol_act/patga1966307/ 2. Poisons and Therapeutic Regulation (2008) http://www.legislation.nsw.gov.au/sessionalview/sessional/sr/2008-392.pdf 3. MIMS Online: http://proxy36.use.hcn.com.au/Search/Search.aspx 4. Australian Medicines Handbook (2011) AMH Adelaide 5. Therapeutics Guidelines, Palliative Care Version 3 (2010) eviQ Opioid Calculator https://www.eviq.org.au/OpioidCalculator.aspx Therapeutic Guidelines, Analgesia Version 5 (2007) Therapeutic Guidelines, Psychotropic Version 6 (2008) Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 21 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc Available Opioid Formulations and Equivalency
The following is a list of the currently available opioid formulations in Australia. Preparations are available as immediate release or as modified released formulations. Modified-release formulations should never be crushed or chewed, as this destroys their release properties and can result in a large dose being absorbed over a short period. Please note that all conversions listed are a guide only and may vary according to the clinical situation, condition of the patient and previous analgesic
requirements.
Trade name
Release Rate
Formulation
Oral morphine (PO) equivalent dose*
5, 10 and 20 mcg/hr transdermal (TD) 50 mg PO morphine = 20 mcg TD patch 7.5 mg PO morphine = 60 mg PO codeine Codeine/Paracetamol Immediate 30/500 mg tablets 2 tablets = 7.5 mg PO morphine eg.Panadeine Forte®** Codeine/Paracetamol Immediate 8/500 mg tablets 2 tablets = 2 mg PO morphine eg.Panadeine®** Conversions from transdermal fentanyl to 12, 25, 50, 75 and 100 mcg/hr other opioids are imprecise and poorly transdermal (TD) patch studied. The calculator uses conversion figures provided by the manufacturer. 50 mcg/ml injection 25 mg PO morphine= 100 mcg fentanyl Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 22 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc 2, 4 and 8 mg tablets 10 mg PO morphine = 1.67 mg PO Dilaudid 1 mg/ml oral liquid 10 mg PO morphine = 1.67 mg PO Dilaudid 2 mg/ml and 10 mg/ml injection 20 mg PO morphine = 1 mg IV Dilaudid 10 mg/ml injection 20 mg PO morphine= 1 mg IV Dilaudid 4, 8, 16, 32 and 64 mg tablets 4 mg PO Jurnista = 24 mg PO morphine 10 and 20 mg tablets Direct equivalent Direct equivalent 1mg, 2mg, 5mg and 10mg/ml oral Direct equivalent 10, 20, 50 and 100 mg capsules Direct equivalent 10, 30, 60, 100 mg tablets Direct equivalent 30, 60, 90 and 120 mg capsules Direct equivalent 20, 30, 60, 100 and 200 mg sachets Direct equivalent 5, 10, 15, 30, 60, 100 and 200 mg Direct equivalent Morphine sulfate 5, 10, 15, 30 mg/ml injection 25 mg PO morphine = 10 mg IV morphine Morphine tartrate 80 mg/ml injection 25 mg PO morphine = 10 mg IV morphine 15 mg PO morphine = 10 mg PO Endone 5, 10, and 15 mg capsules 15 mg PO morphine = 10 mg PO OxyNorm 1 mg/ml oral solution 5, 10, 15, 20, 30, 40 and 80 mg 15 mg PO morphine = 10 mg PO OxyContin Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 23 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc 10 mg/ml and 20 mg/2ml injection 20 mg PO morphine = 8 mg IV OxyNorm 10 mg PO morphine = 50 mg PO Tramadol 50 mg/ml injection 10 mg PO morphine = 50 mg PO Tramadol Tramal SR® Zydol® 50, 100, 150 and 200 mg tablets 10 mg PO morphine = 50 mg PO Tramadol 100, 200 and 300 mg tablets 10 mg PO morphine = 50 mg PO Tramadol * Based on the conversions used in the eviQ Opioid Calculator ** Combination products are not in the eviQ calculator as there is no conclusive evidence that combination analgesics containing lower doses of codeine with paracetamol, aspirin or ibuprofen have any benefits over these non-opioids alone. *** The safety and efficacy of Jurnista in children and adolescents under the age of 18 has not been established. Until further experience is gained, Jurnista must not be used in this population Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 24 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc CONVERSION OF MORPHINE Q4H TO A FENTANYL PATCH Oral morphine range q4h
Fentanyl dose mcg/hr
• Ensure patch is calculated using q4h morphine dose To determine the appropriate Fentanyl patch, divide the 24hr oral dose by 3 Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 25 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc

Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 26 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc NURSE PRACTITIONER FORMULARY ENDORSEMENT:
Approved By:
Name
Nursing Council Chairperson Pharmacy and Drug Dr Jeanette Conley Committee Chairperson Palliative Care Specialist Dr Gillian Rothwell (Collaborative arrangement) Medical Advisory Committee Executive Committee Julie Edwards Palliative Care Nurse Practitioner Drug Formulary SAH Page 27 of 27 C: Documents and Settings ledwa Desktop EDWARDS Palliative Care Nurse Practitioner formulary v6 1.doc

Source: http://www.sah.org.au/assets/files/PDFs/Nurse%20Practioners/EDWARDS%20Palliative%20Care%20Nurse%20Practitioner%20formulary%20v6%201.pdf