Home' Australian Pharmacist : Australian Pharmacist October 2012 Contents Australian Pharmacist October 2012 I © Pharmaceutical Society of Australia Ltd.
This content is for information purposes only. The clinical information presented should not be
used to guide clinical advice/decisions without reference to the complete section of the APF.
What can I find out about...
You can find all this and more in the complete
opioid conversion manuscript in your APF.
See pages 200–204.
Visit www.psa.org.au to purchase your copy.
Accreditation number: CP120040d
This activity has been accredited for 0.25 hours of Group 2 CPD
(or 0.5 CPD credits) suitable for inclusion in an individual pharmacist’s CPD plan.
How do I convert from intramuscular morphine to oral
A hospital patient has been receiving 5 mg of intramuscular morphine every two
hours for control of pain. The medical team wants to calculate the equivalent
opioid analgesic dose of controlled-release oxycodone tablets so that the patient
can be discharged from hospital. To account for individual variations, the starting
dose of oxycodone will be reduced to 50% of the calculated equi-analgesic dose.
Based on the information in APF22, what strength of oxycodone
tablets should the patient be commenced on for twice-daily dosing?
Enter your answer and claim 0.5 Group 2 CPD credits.
Visit www.psa.org.au and click submit answers.
What patient factors can
necessitate a change in opioid
A patient might benefit from changing from
one opioid to another because of inadequate
pain control, intolerable adverse effects,
concerns about toxicity, poor adherence,
or the need for a change in the route of
When switching between
opioids, why should the
starting dose of the new opioid
be 50–75% of the calculated
The new opioid should be commenced at a
dose lower than the calculated equi-analgesic
dose to allow for individual variations in
tolerance (the reduced analgesic response
that develops with continued use of a specific
opioid) and minimise the risk of adverse
effects. The dose should then be titrated
according to analgesic response. Because
opioid analgesics differ in potency, metabolic
pathway, pharmacokinetic profile, toxicity,
and interaction with the different opioid
receptors in the body, the tolerance a patient
develops to one opioid cannot be reliably
extrapolated to other opioids.
It found that awareness and knowledge
of prostate cancer has steadily increased
over the past decade, with a 12%
increase in the percentage of men
who feel informed about the disease.
The report shows that men aged 40 to 74
see prostate cancer as the single most
important disease facing Australian men.
According to Dr Anthony Lowe, Chief
Executive of PCFA, the new results
show the positive impact of PCFA’s
The results reflect the importance of
the current work being conducted by
PCFA and other leading organisations to
develop evidence-based guidelines to
help men make informed decisions about
prostate cancer testing and treatment.
More than half (55%) of participants felt
they knew a lot or a reasonable amount
about prostate cancer testing. In addition,
the percentage of participants who
said they knew ‘nothing at all’ about
testing has halved from 27% in 2002 to
11% in 2012. However, nearly 40% of
respondents agreed that the advice about
the usefulness of testing is still confusing.
Interestingly, despite public health
and primary care recommendations
against routine testing for prostate
cancer, GPs were identified as the
main influencers for Prostate Specific
Antigen (PSA) testing and Digital Rectal
Dr Lowe says that based on the results,
‘we are now focused on developing
Australia’s first national guidelines for PSA
testing, expanding the PCFA affiliated
Prostate Cancer Support Group Network,
increasing awareness of the available
support services amongst healthcare
professionals and the wider community
and conducting research into additional
support services for partners and carers.
For a copy of the full report, visit:
Post hospital follow-up
Chronic heart failure (CHF) patients are less
likely to have died a year after discharge
if they are involved in a program of active
follow-up when they return home than
patients given standard care, according
to a new Cochrane systematic review.
These patients were also less likely to need
to go back into hospital in the six months
following discharge. Researchers in the
UK and Australia examined 25 clinical
trials with nearly 6,000 patients. The trials
tested different methods of organising
the care of CHF patients post hospital.
The researchers identified three types of
care: 1) case-management interventions;
2) clinic interventions; 3) multidisciplinary
interventions. Patients who received
case-management intervention had less
‘all cause’ mortality a year after discharge
than those receiving usual care, although
there were no differences at six months
Full citation: Takeda A, Taylor SJC, Taylor RS, Khan F, Krum H,
Underwood M. Clinical service organisation for heart failure. Cochrane
Database of Systematic Reviews 2012, Issue 9. Art. No.: CD002752.
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