end of life

Question 1

what is the most common issues for dying patients?

Answer 1

pain is the most common issues in dying patients

- pain management is key to end of life care

Question 2

opioid toxicity

Answer 2

symptoms usually respond to dose adjustment/switching to another strong opioid. Seek senior advice!
Think about updating renal function when a patient becomes opioid toxic – if renal function is impaired morphine will accumulate as it is renally excreted.
Respiratory depression is a severe side effect of morphine and occurs rarely when it is used correctly

Question 3

symptoms of opioid toxicity

Answer 3

hallucinations
myoclonus
drowsiness.

Question 4

what is naxloxone?

Answer 4

Naloxone can reverse morphine very quickly. Use small doses eg 80micrograms IV bolus every 2 minutes to avoid pain reversal in end of life care

Question 5

what is a syringe driver?

Answer 5

o Oral route for drugs often not possible so switches to continuous subcutaneous infusion using a syringe driver
o Subcutaneous access via butterfly needle with connector tubing
o Up to 3 medicines can be mixed together in the syringe
o Infused over 24 hours, changed daily
o Portable
o Can be used in most care settings

Question 6

how much scut morphine do you give compared to oral?

Answer 6

• SCUT morphine is twice as strong as ORAL morphine – To work out SCUT dose, divide the total daily oral morphine dose by 2