Anticipatory medications in Palliative care

Question 1

What are the 4 main classes of anticipatory medication?

Answer 1

Analgesia
Anti-emetic
Anxiolytic
Anti-secretory

Question 2

What pain relief is usually used first-line for opiate naive patients?

Answer 2

Morphine sulphate 1-2.5mg subcutaneous

If eGFR <50, Oxycodone 1 – 2 mg SC

Question 3

Which anti-emetic is commonly used for nausea and vomiting in palliative care?

Answer 3

0.5 – 1.5mg SC Haloperidol.

Do not repeat within 4 hours, maximum dose 3mg in 24 hours.

Question 4

What are key signs of agitation in end of life care?

Answer 4

fidgeting, moving arms and legs
Confusion
Vocalisations

Question 5

Anxiolytic used for agitation

Answer 5

Midazolam 2.5-5mg subcutaneous

Max 4 doses in 24h

Question 6

What drug is used for excessive secretions/rattle?

Answer 6

Hyoscine butylbromide 20mg SC.

Do not repeat within 1-hour, maximum dose 120mg in 24 hours

Question 7

Indications for a syringe driver

Answer 7

Requiring two or more doses of any one of the anticipatory medications in a 24 hour period.

Being unable to take oral medications that need replacing (e.g. modified release opiates, anti-epileptic medications).

Question 8

Why are syringe drivers so effective?

Answer 8

Continuous infusion provides a constant level of medication to the patient, which helps to achieve better symptom control.