Care of the dying Flashcards
what to prescribe first for EoL patients?
PRN as required medications
to avoid patient receiving lots of injections?
syringe driver
the major 4 PRN drugs in caring for the dying?
1) antisecretion
- HYOSCINE H (400 mcg 4 hrly, or continuous S/C infusion 1.2–2 mg/24 hrs)
- hyoscine BB (S/C infusion 20–120 mg/24 hours)
2) agitation
- MIDAZOLAM (10-20mg/24hrs)
3) pain
- MORPHINE 10mg/24hr if new
4) nausea
- CYCLIZINE 150mg/24hr
how often is morphine/opioid given for pain?
- either immediate-release 30mg 4 hrly
- or modified- release 100mg 12 hrly
- rescue doses
how to manage breakthrough pain?
rescue dose immediate-release
1/10 to 1/6 of regular 24-hour dose
repeated every 2–4 hours PRN
how to increase background regular dose of morphine?
(n.o. rescue doses & response to them should be taken into account)
increase should not exceed 1/3 to 1/2 total daily dose
when to stop the upward titration of morphine?
when pain is relieved or unacceptable S/E
what to use if patients cannot tolerate morphine?
cxycodone hydrochloride
when to avoid oral drugs?
dysphagia
vomiting
bowel obstruction
terminal phase
Tx to use for ↑ ICP, nerve compression, liver capsule pain, soft tissue infiltration?
steroids
Tx for muscle cramp/spasms, myofascial pain?
Muscle relaxants (e.g. baclofen, benzodiazepines)
Tx for bone pain?
Bisphosphonates
Tx for bowel colic, bladder spasm?
Antispasmodic (e.g. hyoscine butylbromide)
opioids if GFR<30?
avoid regular codeine, morphine and oxycodone (low dose immediate release (IR) oxycodone with increased dose intervals may be appropriate sometimes)
Consider fentanyl, buprenorphine or alfentanil depending on type of
pain and preferred route
Tx S/E of opioids?
- C: stimulant laxative (senna) +/- softener (docusate)
- N/V: PRN anti-emetic (haloperidol/metoclopramide)
- Sedation: dose reduction, alternative analgesic
- Dry mouth: good oral hygiene +/- saliva stimulants/artificial