Pharmacopalliation
@pharmacopalliation.bsky.social
Palliative care pharmacist MRPharmS (Consultant)👨⚕️ Independent prescriber 📝 Part time researcher 🔬 @theASPCP deputy chair 💊 All views are my own
Reposted by Pharmacopalliation
💊 Haloperidol PK fact:
Lipophilic, distributes widely into brain & fat
Brain conc. = 10–30× higher than serum
Serum t½: ~15–30h
Brain t½: ~6.8 days
👉 Even weeks after stopping, brain levels may remain clinically relevant.
#PalliativeCare #MedEd #Pharmacology
Lipophilic, distributes widely into brain & fat
Brain conc. = 10–30× higher than serum
Serum t½: ~15–30h
Brain t½: ~6.8 days
👉 Even weeks after stopping, brain levels may remain clinically relevant.
#PalliativeCare #MedEd #Pharmacology
September 5, 2025 at 7:08 AM
💊 Haloperidol PK fact:
Lipophilic, distributes widely into brain & fat
Brain conc. = 10–30× higher than serum
Serum t½: ~15–30h
Brain t½: ~6.8 days
👉 Even weeks after stopping, brain levels may remain clinically relevant.
#PalliativeCare #MedEd #Pharmacology
Lipophilic, distributes widely into brain & fat
Brain conc. = 10–30× higher than serum
Serum t½: ~15–30h
Brain t½: ~6.8 days
👉 Even weeks after stopping, brain levels may remain clinically relevant.
#PalliativeCare #MedEd #Pharmacology
Reposted by Pharmacopalliation
💊FLIP-FLOP KINETICS📉
Have you ever wondered why immediate-release opioids reach steady state quickly, but modified-release formulations can take 2–3 days?
The answer lies in a fascinating pharmacokinetic phenomenon called flip-flop kinetics.
Let’s unpack it simply, using opioids as our guide
🧵
Have you ever wondered why immediate-release opioids reach steady state quickly, but modified-release formulations can take 2–3 days?
The answer lies in a fascinating pharmacokinetic phenomenon called flip-flop kinetics.
Let’s unpack it simply, using opioids as our guide
🧵
September 6, 2025 at 1:33 PM
💊FLIP-FLOP KINETICS📉
Have you ever wondered why immediate-release opioids reach steady state quickly, but modified-release formulations can take 2–3 days?
The answer lies in a fascinating pharmacokinetic phenomenon called flip-flop kinetics.
Let’s unpack it simply, using opioids as our guide
🧵
Have you ever wondered why immediate-release opioids reach steady state quickly, but modified-release formulations can take 2–3 days?
The answer lies in a fascinating pharmacokinetic phenomenon called flip-flop kinetics.
Let’s unpack it simply, using opioids as our guide
🧵
💊FLIP-FLOP KINETICS📉
Have you ever wondered why immediate-release opioids reach steady state quickly, but modified-release formulations can take 2–3 days?
The answer lies in a fascinating pharmacokinetic phenomenon called flip-flop kinetics.
Let’s unpack it simply, using opioids as our guide
🧵
Have you ever wondered why immediate-release opioids reach steady state quickly, but modified-release formulations can take 2–3 days?
The answer lies in a fascinating pharmacokinetic phenomenon called flip-flop kinetics.
Let’s unpack it simply, using opioids as our guide
🧵
September 6, 2025 at 1:33 PM
💊FLIP-FLOP KINETICS📉
Have you ever wondered why immediate-release opioids reach steady state quickly, but modified-release formulations can take 2–3 days?
The answer lies in a fascinating pharmacokinetic phenomenon called flip-flop kinetics.
Let’s unpack it simply, using opioids as our guide
🧵
Have you ever wondered why immediate-release opioids reach steady state quickly, but modified-release formulations can take 2–3 days?
The answer lies in a fascinating pharmacokinetic phenomenon called flip-flop kinetics.
Let’s unpack it simply, using opioids as our guide
🧵
💊 Haloperidol PK fact:
Lipophilic, distributes widely into brain & fat
Brain conc. = 10–30× higher than serum
Serum t½: ~15–30h
Brain t½: ~6.8 days
👉 Even weeks after stopping, brain levels may remain clinically relevant.
#PalliativeCare #MedEd #Pharmacology
Lipophilic, distributes widely into brain & fat
Brain conc. = 10–30× higher than serum
Serum t½: ~15–30h
Brain t½: ~6.8 days
👉 Even weeks after stopping, brain levels may remain clinically relevant.
#PalliativeCare #MedEd #Pharmacology
September 5, 2025 at 7:08 AM
💊 Haloperidol PK fact:
Lipophilic, distributes widely into brain & fat
Brain conc. = 10–30× higher than serum
Serum t½: ~15–30h
Brain t½: ~6.8 days
👉 Even weeks after stopping, brain levels may remain clinically relevant.
#PalliativeCare #MedEd #Pharmacology
Lipophilic, distributes widely into brain & fat
Brain conc. = 10–30× higher than serum
Serum t½: ~15–30h
Brain t½: ~6.8 days
👉 Even weeks after stopping, brain levels may remain clinically relevant.
#PalliativeCare #MedEd #Pharmacology
💡 Midazolam is actually water-soluble in its vial, but becomes lipid-soluble once it enters the body.
That’s unusual for a benzodiazepine. The trick lies in its imidazole ring 👇
That’s unusual for a benzodiazepine. The trick lies in its imidazole ring 👇
August 30, 2025 at 5:52 AM
💡 Midazolam is actually water-soluble in its vial, but becomes lipid-soluble once it enters the body.
That’s unusual for a benzodiazepine. The trick lies in its imidazole ring 👇
That’s unusual for a benzodiazepine. The trick lies in its imidazole ring 👇
💊💊ALFENTANIL💊💊
Alfentanil’s pKa ~6.5, much lower than fentanyl (~8.4) or morphine (~8.0)
At physiologic pH (7.4), ~90% of alfentanil exists in the unionised, lipid-soluble form → crosses the blood–brain barrier very rapidly
This explains why alfentanil has the fastest onset of action of any opioid
Alfentanil’s pKa ~6.5, much lower than fentanyl (~8.4) or morphine (~8.0)
At physiologic pH (7.4), ~90% of alfentanil exists in the unionised, lipid-soluble form → crosses the blood–brain barrier very rapidly
This explains why alfentanil has the fastest onset of action of any opioid
August 27, 2025 at 5:55 PM
💊💊ALFENTANIL💊💊
Alfentanil’s pKa ~6.5, much lower than fentanyl (~8.4) or morphine (~8.0)
At physiologic pH (7.4), ~90% of alfentanil exists in the unionised, lipid-soluble form → crosses the blood–brain barrier very rapidly
This explains why alfentanil has the fastest onset of action of any opioid
Alfentanil’s pKa ~6.5, much lower than fentanyl (~8.4) or morphine (~8.0)
At physiologic pH (7.4), ~90% of alfentanil exists in the unionised, lipid-soluble form → crosses the blood–brain barrier very rapidly
This explains why alfentanil has the fastest onset of action of any opioid
Reposted by Pharmacopalliation
🎉 Excited to announce our new textbook, Oxford case histories in palliative medicine! 🎉
Dive into comprehensive insights and practical approaches to enhance patient care. Thank you to everyone who contributed 👏
📚 #PalliativeCare
Dive into comprehensive insights and practical approaches to enhance patient care. Thank you to everyone who contributed 👏
📚 #PalliativeCare
February 13, 2025 at 7:36 PM
🎉 Excited to announce our new textbook, Oxford case histories in palliative medicine! 🎉
Dive into comprehensive insights and practical approaches to enhance patient care. Thank you to everyone who contributed 👏
📚 #PalliativeCare
Dive into comprehensive insights and practical approaches to enhance patient care. Thank you to everyone who contributed 👏
📚 #PalliativeCare
Reposted by Pharmacopalliation
Edited by palliative medicine physician Dr Jonathan Pickard, and consultant pharmacist Mr Jonathan Hindmarsh, 54 expert authors provide “diagnostic skills and clinical reasoning that helps temper knowledge and understanding with pragmatism and practicality in the face of life-limiting illness.”
February 10, 2025 at 9:10 PM
Edited by palliative medicine physician Dr Jonathan Pickard, and consultant pharmacist Mr Jonathan Hindmarsh, 54 expert authors provide “diagnostic skills and clinical reasoning that helps temper knowledge and understanding with pragmatism and practicality in the face of life-limiting illness.”
Reposted by Pharmacopalliation
It’s finally here! @oxfordunipress.bsky.social Oxford Case Histories in Palliative Medicine “guides medical professionals and trainees through 52 cases curated to illustrate the varied and often complex landscape of palliative medicine.”
oxford.ly/4hG4C9B
oxford.ly/4hG4C9B
February 10, 2025 at 9:10 PM
It’s finally here! @oxfordunipress.bsky.social Oxford Case Histories in Palliative Medicine “guides medical professionals and trainees through 52 cases curated to illustrate the varied and often complex landscape of palliative medicine.”
oxford.ly/4hG4C9B
oxford.ly/4hG4C9B
Reposted by Pharmacopalliation
TRAMADONT: Ten reasons to avoid Tramadol.
a stop sign that is red and white
ALT: a stop sign that is red and white
media.tenor.com
December 6, 2024 at 8:10 PM
TRAMADONT: Ten reasons to avoid Tramadol.
Reposted by Pharmacopalliation
Psychostimulants and depression in palliative care:
A short thread 🧵
A short thread 🧵
December 9, 2024 at 4:12 PM
Psychostimulants and depression in palliative care:
A short thread 🧵
A short thread 🧵
Reposted by Pharmacopalliation
When prescribing dexamethasone, remember enzyme inducers, such as carbamazepine and phenytoin, can significantly reduce its serum levels. In some cases dexamethasone doses may need to be increased 2 - 4 fold! Particular caution needed in high risk indications such as MSCC!
December 14, 2024 at 8:26 PM
When prescribing dexamethasone, remember enzyme inducers, such as carbamazepine and phenytoin, can significantly reduce its serum levels. In some cases dexamethasone doses may need to be increased 2 - 4 fold! Particular caution needed in high risk indications such as MSCC!
When prescribing dexamethasone, remember enzyme inducers, such as carbamazepine and phenytoin, can significantly reduce its serum levels. In some cases dexamethasone doses may need to be increased 2 - 4 fold! Particular caution needed in high risk indications such as MSCC!
December 14, 2024 at 8:26 PM
When prescribing dexamethasone, remember enzyme inducers, such as carbamazepine and phenytoin, can significantly reduce its serum levels. In some cases dexamethasone doses may need to be increased 2 - 4 fold! Particular caution needed in high risk indications such as MSCC!
An option for bowel obstruction?
December 13, 2024 at 8:14 PM
An option for bowel obstruction?
It’s still surreal to see our textbook available for preorder! 📚 Thank you to everyone who contributed. Excited to share this work and knowledge. #newbook #academia #palliativecare
December 9, 2024 at 8:14 PM
It’s still surreal to see our textbook available for preorder! 📚 Thank you to everyone who contributed. Excited to share this work and knowledge. #newbook #academia #palliativecare
Psychostimulants and depression in palliative care:
A short thread 🧵
A short thread 🧵
December 9, 2024 at 4:12 PM
Psychostimulants and depression in palliative care:
A short thread 🧵
A short thread 🧵
Anyone else using 4 - 6 ml of Nystatin QDS for oral thrush? I get asked "are you sure?" every time I prescribe it.
December 8, 2024 at 6:42 PM
Anyone else using 4 - 6 ml of Nystatin QDS for oral thrush? I get asked "are you sure?" every time I prescribe it.
Reposted by Pharmacopalliation
3. Evidence assessing the use of tramadol for the management neuropathic pain comes from small, largely inadequate studies with potential sources of bias. The evidence of benefit from tramadol was of low or very low quality.
pubmed.ncbi.nlm.nih.gov/28616956/
pubmed.ncbi.nlm.nih.gov/28616956/
Tramadol for neuropathic pain in adults - PubMed
There is only modest information about the use of tramadol in neuropathic pain, coming from small, largely inadequate studies with potential risk of bias. That bias would normally increase the apparen...
pubmed.ncbi.nlm.nih.gov
December 6, 2024 at 8:10 PM
3. Evidence assessing the use of tramadol for the management neuropathic pain comes from small, largely inadequate studies with potential sources of bias. The evidence of benefit from tramadol was of low or very low quality.
pubmed.ncbi.nlm.nih.gov/28616956/
pubmed.ncbi.nlm.nih.gov/28616956/
Reposted by Pharmacopalliation
6. Tramadol is one of two opioids linked with hypoglycaemia, the other being methadone.
pubmed.ncbi.nlm.nih.gov/25485799/
pubmed.ncbi.nlm.nih.gov/25485799/
Tramadol use and the risk of hospitalization for hypoglycemia in patients with noncancer pain - PubMed
The initiation of tramadol therapy is associated with an increased risk of hypoglycemia requiring hospitalization. Additional studies are needed to confirm this rare but potentially fatal adverse even...
pubmed.ncbi.nlm.nih.gov
December 6, 2024 at 8:10 PM
6. Tramadol is one of two opioids linked with hypoglycaemia, the other being methadone.
pubmed.ncbi.nlm.nih.gov/25485799/
pubmed.ncbi.nlm.nih.gov/25485799/
Reposted by Pharmacopalliation
The other way to prevent NAGMA is to replete potassium with K-Citrate (PO) or K-Acetate (IV).
KCl causes hyperchloremic acidosis (like normal saline!), so giving tons of KCl will drive down the pH 😟
citrate or acetate are metabolized into bicarb, so they're alkalinizing and will *improve* pH 😛
KCl causes hyperchloremic acidosis (like normal saline!), so giving tons of KCl will drive down the pH 😟
citrate or acetate are metabolized into bicarb, so they're alkalinizing and will *improve* pH 😛
a little girl in a red jacket is looking up at something in the sky .
ALT: a little girl in a red jacket is looking up at something in the sky .
media.tenor.com
December 6, 2024 at 8:55 PM
The other way to prevent NAGMA is to replete potassium with K-Citrate (PO) or K-Acetate (IV).
KCl causes hyperchloremic acidosis (like normal saline!), so giving tons of KCl will drive down the pH 😟
citrate or acetate are metabolized into bicarb, so they're alkalinizing and will *improve* pH 😛
KCl causes hyperchloremic acidosis (like normal saline!), so giving tons of KCl will drive down the pH 😟
citrate or acetate are metabolized into bicarb, so they're alkalinizing and will *improve* pH 😛
Reposted by Pharmacopalliation
Short-lived breathlessness or pain may resolve before PRN oral opioids can take effect (oral morphine starts to work after 15 - 30 minutes, peak effect may take upwards of one hour), in such circumstances the patient may derive little benefit but experience adverse effects.
#palliativecare #pain
#palliativecare #pain
December 4, 2024 at 8:02 PM
Short-lived breathlessness or pain may resolve before PRN oral opioids can take effect (oral morphine starts to work after 15 - 30 minutes, peak effect may take upwards of one hour), in such circumstances the patient may derive little benefit but experience adverse effects.
#palliativecare #pain
#palliativecare #pain
TRAMADONT: Ten reasons to avoid Tramadol.
a stop sign that is red and white
ALT: a stop sign that is red and white
media.tenor.com
December 6, 2024 at 8:10 PM
TRAMADONT: Ten reasons to avoid Tramadol.