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Continuous subcutaneous infusions

As a patient approaches end of life, it is appropriate to discontinue unnecessary drugs and where possible convert those which must continue to subcutaneous injections or infusions. Anticipatory prescribing at …

Opioid tolerance

Tolerance is defined as the need for increasing doses of an opioid to achieve the same effect. It is a normal physiological phenomenon, occurring as a consequence of the opioid …

Managing cancer pain: want to learn more?

We hope this course has energised you to practice, promote and support safe opioid prescribing. You may also be motivated to learn more about pain management in cancer and palliative …

Specific opioid issues in renal failure

This step describes some specific opioid issues which you may encounter in clinical practice. Weak opioids Dihydrocodeine has not been studied in renal failure, so should be avoided. The clearance …

If opioids are no longer working

In this step we will consider what to do if your patient’s pain is no longer responding to opioids. Cancer progression The most common reason for opioids to seemingly lose …

Converting opioids

The most common reason to convert opioids is to reduce side effects arising from the accumulation of toxic metabolites. It is therefore an important patient safety skill to master. In …

Opioids in renal failure

Prescribing opioids in renal failure is informed by knowledge of the pharmacology of the drug, in particular the production and accumulation of any toxic metabolites. The priority is always to …

Recognising opioid toxicity

Opioid overdose can be lethal. Careful prescribing and monitoring, following guidance provided in this course, reduces the risk of serious, adverse events. Clinicians must be able to recognise opioid toxicity …

Managing opioid toxicity

The management of opioid toxicity depends on its severity and causative factors. Respiratory depression Suspect opioid-induced respiratory depression if the patient’s respiratory rate is below the normal (12-20 respirations per …

Introduction to Week 3

In this video Dr Victoria Hewitt introduces the last week of the course, which explores some opioid-related problems in practice. Prescribing strong opioids is both complex and risky. Some side …

Common side effects of opioids

Opioids can produce many adverse effects, ranging from mild and transitory to severe, distressing and life-threatening. Healthcare professionals who prescribe opioids or care for patients who are taking them should …

Switching routes – oral to injection

Opioids should be given by mouth unless there is a compelling reason not to do so. If the oral route is not viable (for instance the patient is vomiting or …

Titrating morphine

After his Specialist Nurse prescribed his morphine, Terry’s pain has been well controlled. At first he did feel a bit nauseous but that soon wore off. He didn’t need any …

Switching opioids

Sometimes it is necessary to switch from one opioid to another. This step explains the principles underpinning opioid switching. Morphine is the first-line opioid of choice but sometimes it is …