End of life care

Question 1

How do you treat uncontrolled pain?
Side effects, toxicity, mx

Answer 1

Side effects:
- Constipation: Occurs in almost all patients.
*Always ensure patient is prescribed a laxative.
- Nausea and vomiting: Anti-emetic of choice for opioid-induced nausea and vomiting:
Haloperidol.
- Drowsiness and mental clouding
- Hallucinations and confusion
- Dry mouth
- Advice about driving

Opioid toxicity signs:
- sedation
- resp depression
- myoclonus
- pinpoint pupils

• Mild
  If resp rate ≥ 8, rousable and not cyanosed, reduce or omit next opioid dose
• Severe
  If resp rate < 8, give 20 micrograms Naloxone IV every 2 minutes until resp rate
  improves. Further boluses may be needed at 30-60minutes, may need infusion

Question 2

How do we know someone is dying?

Answer 2

•Biochemically​
⚬Raised lactate​
⚬Catastrophic bloods or imaging​
•Level of consciousness​
•Eating and drinking​
•Breathing​
⚬Cheyne-stokes breathing pattern​
•Confusion​

Question 3

What are the types of pain?

Answer 3

Question 4

What are the end of life drugs?

Answer 4

1. Pain Relief
   • Morphine or other opioids (e.g., hydromorphone, fentanyl) for moderate to severe pain.
   
   2. Dyspnea (Breathlessness)
      • Opioids (like morphine) for relief of breathlessness.
   3. Nausea and Vomiting
      • Metoclopramide, ondansetron, or haloperidol for nausea management.
   4. Anxiety or Agitation
      • Midazolam or lorazepam for anxiety, agitation, or restlessness.