Medications Flashcards
What should you bear in mind with the maximum paracetamol doses?
Check pt weighs enough - <50kg cant have max dose !!
Do they have any liver impairment?
How do NSAIDs work?
inhibit COX (main enzyme for PG synth), can be selective (celecoxib) or non-selective (ibuprofen), work peripherally and CNS
What are some examples of weak opioids?
codeine, tramadol, dihydrocodeine
What are SE of opioids? what are their adverse effects?
Constipation, nausea, sedated, dry mouth = common
Allergy, resp depress, pruritis = rare
Adverse: Psychomimetic, confused, myoclonus
What are some strong opioids?
morphine, fentanyl, oxycodone, Alfentanil, Bupnerphoine
How is the PRN opioid dose calculated?
General rule: as needed is 1/6th - 1/10th of 24hr for PRN
Which opioids are renal friendly?
Tramadol, Fentanyl, Buprenorphine are nenal friendly
Give the equivalent dose of codeien/ tramadol to morphine and morphines equivalence to oxycodone
codeine/ tram are 1/10th potency of morphine
Oxycodone twice as potent as morphine
Which opioids are usually given in patch form?
Fentanyl and buprenorphine (remember heat increases absorption rate)
Give some examples of moderate release opioids, how long do they last?
12 hrs eg MST, oxycontin
Give some examples of immediate release opioids, how long do they last?
4 hrs eg oramorph, oxynorm
What is more potent injectable or PO opioids?
Injectable 2x as potent as PO
What is the difference between an unlicensed and off licence drug?
Unlicensed = medicine isn't licensed Off-licence = route/ dose/ indication isn't licensed
What are the issues with the different routes of administering meds in palliative care?
SC is generally preferred for parenteral route
IM and IV - may be painful and difficult w cachexia
SL/ buccal - mouth may be too dry
Inhalation - coordination may be an issue
What anti-emitic is first line for gastric stasis? How does it work?
Prokinetic agents (prokinetic action is separate to D2 action) eg Metoclopramide, Domperidone, act on D2 receptors
Name SE for the prokinetic agents
Side-effects for metoclopramide include extrapyramidal symptoms, drowsiness, diarrhoea, gynaecomastia, galactorrhoea and hyperprolactinaemia.
Side-effects for domperidone include QT-prolongation, drowsiness, dry mouth, diarrhoea and malaise
What is an example of a Butyrophenone antipsychotic anti-emitic, how does it work and what are its SE?
eg haloperidol - act on D2 receptors in CTZ, used for opioid induced nausea.
SE = extrapyramidal, QT prolong, depression
What is an example of a Phenothiazine antipsychotic anti-emitic? How does it work?
eg Levomepromazine, Prochlorperazine. - act on at Dopamine, H1 and Ach-receptors, used when non-specific or multi-factorial causes, avoid in parkinsons
What is an example of a 5-HT3 antagonist? What are some SE?
eg ondansetron. Acts on 5-HT3-receptors. Used for chemo/ radio N+V. SE: constipation, flush, headache, involuntary movement, QT prolong NOT GOOD IN PALLIATIVE AS CAUSES CONSTIPATION
What antihistamine anti-emitics are used? What are some SE?
Anti-histamines eg cyclizine, Cinnarizine, Promethazine - act on H1 receptors, used in obstruction, raised ICP and vestibular causes.
SE: anti-muscarinic effects, palpitations & arrhythmias, sleep disturbances, extra-pyramidal symptoms
Name some antimuscarinic anti-emitics. What else are they used for?
Antimuscarinics eg Hyoscine butylbromide, Hyoscine hydrobromide- used on Ach receptors, used in SM spasm; secretions, death rattle
WHat are the medications usually used in pre-emptive prescribing? What are they trying to address?
morphine (SOB and pain), buscopan (secretions), midazolam (agitation), haloperidol (nausea- for new onset)
Name some antitussives vs protussives
anti-cough: Opioids eg morphine and codeine
Demulcents eg cough syrup
Pro-cough: Encourage better cough clearance eg sodium chloride nebs or Carbocisteine
How is SOB treated in palliative care?
Opioids - decrease resp effort, consider modified release for ongoing SOB
Benzos - evidence limited, for panic aspect ((Anxiolytic - reduced perception of SOB)
Beta agonists - salbutamol, terbutaline
Antimuscarinics eg ipratropium - better for COPD
Steroids - diminish inflamm, decreased effect over time
Oxygen - unlikely to benefit in palliative unless o2 v low
Also think OT and PT
What are some examples of pain adjuvants in palliative care?
usually anti-depressants/ anti-epileptic drugsamitriptyline; carbamazepine; gabapentin, pregabalin; clonazepam; duloxetine
What is episodic/ breakthrough pain?
Pt may have PRN pain for episodic/ breakthrough pain → may be incident pain triggered by activity or unpredictable
What is a syringe driver?
SC machine that stays in situ for 3 days so that lots of meds + sodium chloride given in one go to a pt to bring down the need for lots of SC injections
Can meds be prescribed in ml?
NO is always mg/ mcg etc.
What two anti-emitics shouldn’t be prescribed together?
Cyclizine may reduce the effects of metoclopramide
As prokinetic and anti-spasmodic are going to counteract each other
What is sometimes used in palliative care for tiredness?
methylphenidate
