Ageing and End of Life Care Flashcards
what is the first step in the management of pain?
non opioid (e.g. aspirin, paracetamol, NSAID)
+/- adjuvant
what is the second step in the management of pain?
weak opioid for mild-moderate pain (e.g. codeine)
+/- non opioid
+/- adjuvant
what is the third step in the management of pain?
strong opioid for moderate-severe pain (e.g. morphine)
+/- non opioid
+/- adjuvant
what are the two options for prescribing morphine?
slow release - morphine sulphate M/R
immediate release - morphine sulphate I/R
how long does morphine sulphate M/R last and when should it be taken?
12 hours
twice daily
name two brands of morphine sulphate M/R
MST
zomorph
how long does morphine sulphate I/R last and when should it be taken?
four hours
as required
what quantity of morphine sulphate I/R should be given to a patient also on M/R?
1/6 of the total background dose
name two brands of morphine sulphate I/R
oramorph
sevredol
name three symptoms of opioid toxicity
hallucinations
myoclonus
drowsiness
what does opioid toxicity usually respond to?
dose adjustment or switching to another strong opioid
what is a severe side effect of morphine?
respiratory depression
what drug can be administered to reverse morphine and what dose should be given?
naloxone
small doses e.g. 80mcg IV every 2 mins to avoid pain reversal
name a commonly used second line strong opioid
oxycodone
what are the two safest opioids in severe renal impairment?
fentanyl
alfentanil
which is stronger - oxycodone or morphine?
oxycodone is TWICE as strong
if switching from morphine, half the dose
which is stronger - oral or subcutaneous morphine and what should be done when switching between these?
SCUT is twice as strong
divide the total daily oral morphine dose by 2 = SCUT dose
name some conditions that can mimic dying
opioid/drug toxicity sepsis hypercalcaemia AKI hypoglycaemia
what is used when the oral route for drugs is not available at the end of life?
syringe drivers (CSCI)
these provide continuous subcutaneous infusion of drugs
how many medications can be given via a syringe driver at one time?
up to three
what medicine is given in anticipation of pain at the end of life?
morphine 2mg SCUT hourly
if established on opioids - 1/6 daily background dose
what medicine is given in anticipation of SOB at the end of life?
morphine 2mg SCUT hourly
what medicine is given in anticipation of distress at the end of life?
midazolam 2mg SCUT hourly
what medicine is given in anticipation of nausea at the end of life?
levomepromazine 2.5mg SCUT 12 hourly
what medicine is given in anticipation of respiratory secretions at the end of life?
buscopan 20mg SCUT hourly
what needs to be observed for confirmation of a death?
absence of carotid pulse for 1 min absence of heart sounds for 1 min absence of respiratory sounds for 1 min no response to painful stimulus fixed dilated pupils
what painful stimulus is used for confirmation of death?
trapezium squeeze
