Pallative Flashcards
Palliative care prescribing: agitation and confusion
correct underling issue
1st line. Haloperidol
2nd. Chlorpromazine, levopromazine
terminal ilness- midazolam
Hiccups
1st line- chlorpomazine
if hepatic lesions use dexamethasone
6 causes of N+V
Reduced Gastric Motility
CHemically Mediated- hypercalcaemia, opioids
Visceral/serosal- constipation
Raised ICP- cerebral metastases
Vestibular- motion related or skull tumours
Cortical- anxiety and pain, fever
managment of N+V
reduced gastric motility- metoclopramide
Chemically mediated - Ondanestron, haloperiodol, levopromazine
Visceral/serosal- cyclizine/ levopromazine
Raised ICP- cyclizine, dexamethasdone
Vestibular- cyclizine
Coritcal- benzo- lorazepam
If the oral route is not possible the parenteral route of administration is preferred
When starting patients on pain releif what medications should we give?
Notable SX
oral modified-release (MR) or oral immediate-release morphine (depending on patient preference. eg- 20-30mg of MR a day with 5mg morphine
laxatives should be prescribed for all patients initiating strong opioids
patients should be advised that nausea is often transient. If it persists then an antiemetic should be offered
drowsiness is usually transient - if it does not settle then adjustment of the dose should be considered
breakthrough dose of morphine
In renal impairment what medication
metastatic bone pain
1/6th total daily dose
oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred
metastatic bone pain respond to strong opioids, bisphosphonates or radiotherapy
if pain not controlled by an opioid how much should we increase by?
30-50%
Oral codeine to oral morphine
Oral tramadol to oral morphine
both divide by 10
oral morphine to oral oxycodone
divide by 1.5/2
Transdermal preparations
a transdermal fentanyl 12 microgram patch equates to approximately 30 mg oral morphine daily
a transdermal buprenorphine 10 microgram patch equates to approximately 24 mg oral morphine daily.
oral to subcut prep
Oral morphine Subcutaneous morphine Divide by 2
Oral morphine Subcutaneous diamorphine Divide by 3
Oral oxycodone Subcutaneous diamorphine Divide by 1.5
oral to subcut prep
Oral morphine Subcutaneous morphine Divide by 2
Oral morphine Subcutaneous diamorphine Divide by 3
Oral oxycodone Subcutaneous diamorphine Divide by 1.5
Secretions management
Avoiding fluid overload - particularly stopping IV or subcutaneous fluids
Educating the family that the patient is likely not troubled by secretions
hyoscine hydrobromide or hyoscine butylbromide is generally used first-line
painful mouth lesions management
benzydamine hydrochloride
