Palliative Care Malignant Wounds Compounding Pharmacy’s Approach Dennis Wong, B.Sc. (Pharm.) CD Whyte Ridge Pharmacy 123 G Scurfield Blvd., Winnipeg (204)-488-1819 cindenrx@mts.net

Incident Pain Medications Topical Dosage Forms Medications and Bases

Incident Pain Medications Fentanyl, Sufentanil Sublingual Short acting opioids, injectable Works within 10 to 15minutes and last about ~ 1 hour Hold liquid under the tongue for about 10 minutes if possible without swallowing it May be repeated up to two more doses at 10-15 minutes intervals Pt keep it SL for 10min, Pre-fill syringes, Filtered Needles, if pt cannot hold liq properly, then lollipops, lozenges

Flavoured Fentanyl SL, Lollipops, Lozeges Nasal Spray - Sufentanil in metered dose nasal sprayer which delivers 0.1mL per spray - one or more sprays approximately 10 to 15 minutes prior to activity. Incident Pain Protocol (www.palliative.info)

Topical Dosage Forms Topical Sprays Wound Dressing Gels Radiation Burn Gel Mouthwash, Mouth Gel

- 2 to 4 sprays to surrounding area or specific painful spots Topical Spray - 0.1mL per spray - 2 to 4 sprays to surrounding area or specific painful spots Wound Dressing gel - Aqueous gel, Glycol base Gel - Polyox Bandage Radiation Burn gel - protective artificial skin layer Aq gel easy to wash off with Normal saline, polyox bandage is cellulose powder mixture that you can mix medications in it, abosrb fluid so good for oozing wounds, puff it to wound, spray with NS & puff again until you get a few layer, can be wash away with NS irrigation

Mouthwash - medications to coat the mouth, treat pain, infections Mouth Gel - slow released protective coating

Medications and Bases Topical Sprays - Morphine Sulfate, Hydomorphone HCl, Methadone HCl - Normal Saline, Proplylene Glycol, Ethoxy Diglycol, DMAE Wound Dressing Gels - Lidocaine, Tetraciane, Morphine Sulfate, Hydromorphone HCl, Methadone HCl

For Bed Sore Ulcer Wounds - same pain medications - Aloe Vera, Phenytion, Misoprostol Metronidazole Base Bases - Intrasite Gel, Cellulose (Med Visc) Gel, Propylene Glycol, Ethoxy Diglycol, DMAE

Radiation Burn Gel - Lidocaine, Tetracaine, Morphine, Hydromorphone, NSAID, Antibiotics, Aloe Vera - Pluronic F127 Gel (Carbomer Gel) Mouthwash - Tetracaine HCl, Corticosteroids, Anti-fungal, Anti-viral, Antibiotics, Anti-histamine, Sucralfate - Anti-foaming mouthwash base

Mouth Gel - Morphine Sulfate, Hydromorphone HCl, Glycerin, Lemon - Bioadhesive Slow Released Gel

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