Lecture 10 - Palliative Care Flashcards
8 Domains of Quality Palliative care
- structure and process of care
- physical aspects of care
- psychological and psychiatric aspects of care
- social aspects of care
- spiritual, religious and existential aspects of care
- cultural aspects of care
- care of the pt at the end of life
- ethical and legal aspects of care
For hospice, life expectance has to be under….
6 month
Types of pain
Nociceptive
Neuropathic
Existential
Mixed
How to asses pain
FACES = pictures
Numerical Rating Scale
PQRST
Morphine Dose Adjustments
Renal: avoid in severe impairment
Hepatic: favorable w/ monitoring, inc dosing interval if severe impairment
Oxycodone Dose Adjustments
Renal: favorable with monitoring
Hepatic: cation n monitor, reduce dose 50% or inc dosing interval if severe
Hydromorphone Dose Adjustments
Renal: favorable with monitoring
Hepatic: caution n monitor, reduce dose 50% or inc dosing interval if severe
Fentanyl Dose Adjustments
Renal: preferred opioid in impairment
Hepatic: avoid in severe impairment, reduce doe 50% if mild-moderate
Methadone Dose Adjustments
Renal: preferred opioid in impairment
Hepatic: Avoid liver failure or severe impairment
Adverse effects opioids
constipation
Sedation
Respiratory depression
N/V
Pruritus
Hallucinations
Confusion/delirium
Myoclonus
Morphine dosing
10mg IV = 30mg Oral
Hydrocone to morphine
30mg Oral = 30mg Morphine Oral
Hydromorphone dosing equiv
1.5mg IV = 7.5mg Oral (= 30mg morphine oral)
Oxycodone to morphine equiv
20mg Oral = 30mg Oral morphine
Oxymorphone Dosing equiv
1mg IV = 10mg Oral (= 30mg Morphine oral)
Daily dosage 60-134mg Morphine Fentanyl equiv
25mcg/h patch
Daily dosage 135-224mg Morphine Fentanyl equiv
50mcg/h patch
Daily dosage 225-314mg Morphine Fentanyl equiv
75mcg/h patch
Daily dosage 315-404mg Morphine Fentanyl equiv
100mcg/h
Going from Fentanyl patch to morphine
- remove patch
- for 1-12hrs after, use PRN opioid only
- at 12hrs, start new scheduled opioid at 50% of dose
- at 24hrs, inc new scheduled opioid at 100% of dose
If taking methadone w/ enzyme inducer then….
might need to inc methadone, use rescue opioid
If taking methadone w/ enzyme inhibitor then….
reduce calc dose of methadone by 25% or more, encourage use of rescue opioid
Appropriate Methadone Candidates
True morphine allergy
Sig renal impairment
Neuropathic pain
Opioid-induced adv effects
Pain refractory to other opioids or uncontrolled pain
Cost is an issue
LA opioid preferred
any opioid req patient
Supplemental opioids
want to use same as Long acting
should be about 10-15% of Total daily dose, can be used Q1-6h PRN
