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All content on Aidstat.com is created for healthcare professionals’ educational use only. It is not medical advice, or a substitute for clinical judgment, or patient/personal guidance. Always consult a qualified provider for diagnoses/treatment and verify practices with FDA/EMA/local guidelines. Aidstat assumes no liability for risks arising from the use of this information.
Just In Case Prescribing Calculator
Table of Contents
**Updates**
We updated this page on 21st of July 2025, added interactive PSA Density Calculator that can be used with either blood results or MRI report. Added a detailed explanation of how the calculator works, and added more related questions to the FAQs section.
This page helps with just-in-case medication prescribing. It is for patients in their last days of life. Always use your local guidelines as the primary source. The calculator is a support tool only. Do not rely on it for clinical decisions.
Managing Pain
Pain
Dosing in eGFR>30
Pain
Dosing in Hepatic Impairment
A patient has required 3 doses of Morphine 2.5 mg SC over the last 24 hours.
Renal Impairment (eGFR < 30): Avoid Morphine.
Its metabolites can build up. This causes toxicity and myoclonic jerks.
Use Oxycodone instead. Fentanyl can be used as an alternative.
- Patches:
- If already on a patch, leave in place and change as usual.
- To calculate dose of PRN opiod:
- 1. Convert patch to approximate 24hr total oral morphine equivalent.
- 2. Then convert 24hr total oral morphine equivalent to PRN oral/SC dose.
- *refer to the BNF Prescribing in Palliative Care page for conversions and equivalence tables.*
Syringe Driver (CSCI): Consider starting a CSCI if two or more PRN doses are needed in 24 hours.
CSCI Calculation: Add up the total PRN doses given in 24 hours. This is your starting 24-hour CSCI dose. For patients on oral opioids, divide the total 24-hour oral morphine dose by two.
The breakthrough PRN dose is 1/6th of the total 24-hour CSCI dose.
For more detail, see the Syringe Driver (CSCI) Considerations section below.
Managing Nausea or Vomiting
Nausea or Vomiting
Dosing in eGFR>30
Nausea or Vomiting
Dosing in Hepatic Impairment
A patient has needed 2 doses of Levomepromazine 2.5 mg SC for nausea in 24 hours.
Heart Failure: Avoid Cyclizine. It can worsen fluid retention and heart rate. Use Haloperidol or Levomepromazine.
Bowel Obstruction: Avoid Metoclopramide. It is a pro-kinetic drug. It can worsen abdominal colic pain.
Parkinson's Disease: Avoid dopamine blockers. These include Levomepromazine and Haloperidol. They can worsen Parkinson's symptoms. Use Cyclizine instead.
Syringe Driver (CSCI): Consider a CSCI if two or more PRN doses are needed in 24 hours.
CSCI Calculation: Start with Levomepromazine 6.25 mg to 12.5 mg over 24 hours.
For more detail, see the Syringe Driver (CSCI) Considerations section below.
Managing Breathlessness
Breathlessness
Dosing in eGFR>30
Breathlessness
Dosing in Hepatic Impairment
Low dose opioids help with relieving breathlessness, and are more effective when given by CSCI or modified release oral medication.
Renal Impairment (eGFR < 30): Avoid Morphine
Its metabolites can accumulate and cause harm.
- Use Oxycodone instead. Fentanyl can be used as an alternative.
Syringe Driver (CSCI): Consider a CSCI if breathlessness is persistent.
CSCI Calculation: Start with Morphine 5 mg to 10 mg over 24 hours.
If associated anxiety/fear is concurrent, also prescribe benzodiazepines such as Midazolam or Levomepromazine.
SC dose: Midazolam 2.5mg-5mg/STAT hourly PRN.
- Hepatic & renal impairment dose: Midazolam 1mg - 2.5mg/STAT hourly PRN.
It can be added to CSCI if required starting at dose of Midazolam 5 mg over 24 hours.
For more detail, see the Syringe Driver (CSCI) Considerations section below.
How to use Just In Case Calculator
- Find your Total Cholesterol and HDL Cholesterol values from your blood test report.
- Select the correct unit (mg/dL or mmol/L).
- Enter your values into the fields below and click "Calculate" to get your cholesterol ratio.
- If you need to redo, click "Reset" to start fresh.
**All information is private, no data is saved or shared. You can print your results for easy reference or to share with your doctor or healthcare provider.**
- Find your Total Cholesterol and HDL Cholesterol values from your blood test report.
- Select the correct unit (mg/dL or mmol/L).
- Enter your values into the fields below and click "Calculate" to get your cholesterol ratio.
- If you need to redo, click "Reset" to start fresh.
**All information is private, no data is saved or shared. You can print your results for easy reference or to share with your doctor or healthcare provider.**
Just In Case Calculator
Disclaimer
The online clinical calculators provided on Aidstat.com are intended for informational purposes only. They are not a substitute for clinical reasoning, professional judgement, or expert advice from qualified healthcare practitioners.
While extensive effort has been made to ensure the accuracy and completeness of the information provided by these calculators, Aidstat.com cannot guarantee its accuracy or reliability. Users are advised to independently verify any results obtained through the use of these tools before making any medical or healthcare decisions.
JIC (Just-In-Case) Prescribing Calculator
Last Days of Life Comfort Care - Based on North West Coast Guidelines 2025
Critical factor for drug selection and dosing
Clinical Guidance: If ≥2 PRN doses required in 24 hours → review and consider CSCI. Individualise doses for patient factors. Seek specialist advice for complex cases.
FAQs
Q1. What’s the difference between Cholesterol Ratio and Triglyceride/HDL Ratio?
- PSAD above 0.20 ng/mL/cc - Higher prostate cancer risk.
- PSAD between 0.10-0.15 ng/mL/cc - Intermediate cancer risk.
- PSAD below 0.10 ng/mL/cc - Lower risk for significant disease.
Q2. What will happen if my PSA is raised?
- First, confirm raised PSA by repeating the test, importantly after addressing any temporary causes such as infections that could have caused it.
- Additional tests like free-to-total PSA ratio or MRI can help assess prostate health.
- Then a shared decision making process guides what further steps to be taken based on test results and individual patient factors.
Q3. Does a high PSA mean I have cancer?
- No, high PSA doesn't always mean cancer. Many non-cancerous conditions can cause high PSA.
- About 70% of elevated PSA results are false positives, with only 25% of biopsies finding cancer.
- Doctors consider multiple factors, including age and other tests, to get a better assessment of prostate health.
Q4. What is Normal PSA Density by Age?
- Below 50 years: Normal PSAD is usually below 0.10 ng/mL².
- 50-59 years: PSAD up to 0.15 ng/mL² can be considered normal.
- 60-69 years: Normal PSAD can reach 0.20 ng/mL².
- over 70 years: PSAD may approach 0.25 ng/mL².
Q5. What medications can increase PSA levels?
- Testosterone replacement therapy, especially intramuscular injections, can raise PSA.
- Corticosteroids, like betamethasone, can also increase PSA levels in some cases.
- On the other hand, medications such as 5α-reductase inhibitors (eg. Finasteride, Dutasteride), NSAIDs, statins, and thiazide diuretics can lower PSA levels.
Q6. What can cause a false high PSA reading?
- Recent ejaculation can lead PSA rising temporarily, especially in men over 50.
- Intense exercise such as cycling, or physical activities involving the prostate can also increase PSA levels.
- Prostate infections, swelling, or certain medical procedures like having a catheter can result in higher PSA readings.
Q7. How to Lower PSA Levels?
- Evidence suggests incorporate dietary changes like consuming cooked tomato products rich in lycopene, a powerful antioxidant, can help.
- Adopting a healthy lifestyle with regular exercise, stress management, and increased fibre intake.
- Consult healthcare providers before making any significant changes to your diet or start supplementing. They can help you with creating a personalised plan that works for you whether it be natural approach or using tried and tested medicines.
References
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2. Cornford, P., van den Bergh, R.C.N., Briers, E., Van den Broeck, T., Brunckhorst, O., Darraugh, J., Eberli, D., De Meerleer, G., De Santis, M., Farolfi, A., Gandaglia, G., Gillessen, S., Grivas, N., Henry, A.M., Lardas, M., van Leenders, G.J.L.H., Liew, M., Linares Espinos, E., Oldenburg, J. and van Oort, I.M. (2024). EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. European Urology, [online] 86(2), pp.S0302-2838(24)022541. doi:https://doi.org/10.1016/j.eururo.2024.03.027. Link
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4. Grammatikopoulou, M.G., Gkiouras, K., Papageorgiou, S.Τ., Myrogiannis, I., Mykoniatis, I., Papamitsou, T., Bogdanos, D.P. and Goulis, D.G. (2020). Dietary Factors and Supplements Influencing Prostate-Specific Antigen (PSA) Concentrations in Men with Prostate Cancer and Increased Cancer Risk: An Evidence Analysis Review Based on Randomized Controlled Trials. Nutrients, [online] 12(10). doi:https://doi.org/10.3390/nu12102985. Link
5. Hébert, J.R., Hurley, T.G., Harmon, B.E., Heiney, S., Hebert, C.J. and Steck, S.E. (2012). A diet, physical activity, and stress reduction intervention in men with rising prostate-specific antigen after treatment for prostate cancer. Cancer Epidemiology, 36(2), pp.e128–e136. doi:https://doi.org/10.1016/j.canep.2011.09.008. Link
6. Lumbreras, B., Parker, L.A., Caballero-Romeu, J.P., Gómez-Pérez, L., Puig-García, M., López-Garrigós, M., García, N. and Hernández-Aguado, I. (2022). Variables Associated with False-Positive PSA Results: A Cohort Study with Real-World Data. Cancers, [online] 15(1), p.261. doi:https://doi.org/10.3390/cancers15010261. Link
7. Madej, A., Wilkosz, J., Różański, W. and Lipiński, M. (2012). Complication rates after prostate biopsy according to the number of sampled cores. Central European Journal of Urology, [online] 65(3), pp.116–118. doi:https://doi.org/10.5173/ceju.2012.03.art3. Link
8. Pellegrino, F., Tin, A.L., Martini, A., Vertosick, E.A., Porwal, S.P., Stabile, A., Giorgio Gandaglia, Eastham, J.A., Briganti, A., Montorsi, F. and Vickers, A.J. (2022). Prostate-specific Antigen Density Cutoff of 0.15 ng/ml/cc to Propose Prostate Biopsies to Patients with Negative Magnetic Resonance Imaging: Efficient Threshold or Legacy of the Past? European Urology Focus, 9(2), pp.291–297. doi:https://doi.org/10.1016/j.euf.2022.10.002. Link
9. Rajaei, M., Momeni, A., Soleiman Kheiri and Hafez Ghaheri (2013). Effect of ejaculation on serum prostate specific antigen level in screening and non-screening population. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, [online] 18(5), p.387. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3810571/ [Accessed 17 Jun. 2025]. Link
10. Rajendran, I., Lee, K.-L., Liness Thavaraja and Barrett, T. (2023). Risk stratification of prostate cancer with MRI and prostate-specific antigen density-based tool for personalized decision making. The British journal of radiology/British journal of radiology, 97(1153), pp.113–119. doi:https://doi.org/10.1093/bjr/tqad027. Link
11. Uroweb - European Association of Urology. (n.d.). EAU Guidelines on Prostate Cancer - Uroweb. [online] Available at: https://uroweb.org/guidelines/prostate-cancer [Accessed 17 Jun. 2025]. Link
12. van Renterghem, K., Van Koeveringe, G., Achten, R. and van Kerrebroeck, P. (2009). A new algorithm in patients with elevated and/or rising prostate-specific antigen level, minor lower urinary tract symptoms, and negative multisite prostate biopsies. International Urology and Nephrology, 42(1), pp.29–38. doi:https://doi.org/10.1007/s11255-009-9596-z. Link
13. Wei, J.T., Barocas, D., Carlsson, S., Coakley, F., Eggener, S., Etzioni, R., Fine, S.W., Han, M., Kim, S.K., Kirkby, E., Konety, B.R., Miner, M., Moses, K., Nissenberg, M.G., Pinto, P.A., Salami, S.S., Souter, L., Thompson, I.M. and Lin, D.W. (2023). Early Detection of Prostate Cancer: AUA/SUO Guideline Part I: Prostate Cancer Screening. Journal of Urology, 210(1). doi:https://doi.org/10.1097/ju.0000000000003491. Link