Palliative Flashcards
when are syringe drivers indicated in palliative care
unable to take oral meds
what rate are blue syringe drivers
blue = delivery rate in mm per hour
what rate are green syringe drivers
green = mm per 24/hours
what drugs need sodium chloride 0/9% infusion as opposed to water
ket // ocreotide // ondansetron // grainsetron
N+V drugs palliative care (4)
cyclizine // levopromazine // haloperidol // metoclopramide
resp secretion drugs
1 = hyosine brutylybromide // 2 = glycopyronnium bromide
1st line mx anti-emetic palliative care
levomepromazine injection (2.5 - 5mg/sc) // (or metoclopramide)
which anti-emetic palliative drug is incompatible with lots of things
cyclizine
1st line mx for agitation + confusion palliative care
haloperidol
2nd line mx for agitation + confusion palliative care
chlorpromazine, levomepromazine
terminal mx for agitation + confusion palliative care
midazolam
1st, 2nd, 3rd line end of life pain palliative
1 = morhpine or diamorph // 2 = oxycodone // 3 = Alfentanil
what 2 types of morphine are regularly used in palliative care
oral modified release (MR) and immediate release (normal morphine)
1st line pain mx in CKD 4/5
alfenatil
morphine regeime for breakthroigh pain in palliative care
oral 20-30mg of MR release morphine a day+ 1/6 oral morphine (as requried)
what medication should always be prescribed with morphine in palliative care
laxatives (osmeotic eg senna + docusate) // (+/- antiemetic eg metoclopramide)
what is the dose of breakthrough morphine
1/6 of daily dose
what pain relief is recommended to palliative patients with mild-moderate renal impairment
oxycodone
pain relief in severe renal impairment
alfentanil, buprenorphrine, fentanyl
pain relief metastatic bone pain
opioids, bisposophonates, radio
when increasing opioid doses how much should you increae
30-50%
how is oral coedine + tramadol converted to oral morphine
’/, 10
how is oral morphine converted to subcut morphine
’/, 2
how is oral morphine converted to subcut diamorphine
’/, 3
suitable anti-emetic for reduced gastric mobility
prokinetic eg metaclopramide or domperidone (good with opioid constipation)
what causes virsceral pain in paliative care + what to prescribe
constipation - levopromazine or cyclizine
N+V for raised ICP palliative + vestibular
cyclizine +/- dex
mx palliative hiccups
1 = chlorpramazine // 2 = haloperidol, gabapentin // dexamethasone
4 ACPs palliative
midazolam, hyoscine, levomepromazine, morphone
