Analgesia

Question 1

Terminal care - dyspnoea causing distress in a patient not on opioids

Answer 1

Morphine subcutaneous 1 - 2.5 mg

Question 2

Terminal care - dyspnoea causing distress in a patient taking opioids

Answer 2

Use breakthrough dose of opioids prescribed for pain
Increase background opioid dose by 25-50%
Clonazepam or midazolam

Question 3

Terminal phase - respiratory tract infections/secretions

Answer 3

Secretions cause rattle breathing which does not cause distress to the patient
Reposition patient to shift secretions
Suction visible secretions in the oral cavity only
Anticholinergics - glycopyrronium, hyoscine butylbromide