Palliative Flashcards
What is the initial analgesia used in palliative care?
If no comorbidities use 20-30mg of modified release morphine (eg. 15mg BD) with 5mg IR for breakthrough (1/6th daily dose)
How much should you increase opiates by?
Increase by 30-50% when uptitrating
How is metastatic bone pain managed?
- Strong opiods
- Bisphosphonates
- Radiotherapy
- Denosumab
What are the conversions from:
a) oral codeine to oral morphine
b) oral tramadol to oral morphine
a) divide by 10
b) divide by 10
What are the conversions from:
a) oral morphine to oral oxycodone?
b) oral morphine to SC morphine?
c) oral morphine to SC diamorphine?
d) oral morphine to fentanyl patch?
e) oral morphine to burprenorphine patch?
a) divide by 1.5-2
b) divide by 2
c) divide by 3
d) 30mg oral morphine > 12microgram patch
e) 24g oral morphine > 10microgram patch
What is the preferred analgesia in patients with CKD?
Alfentanil
Buprenorphine
Fentanyl
What medication should you use for abdominal colic ?
Anticholinergics (hyoscine butylbromide)
What medication should be used for intractable hiccups?
1st line - chlorpromazine
2nd line - haloperidol, gabapentin
3rd line - dexamethasone (esp if hepatic lesions)
What medication should be used for agitation?
First rule out REVERSIBLE causes!
1st line - haloperidol
2nd line - clorpromazine, levomepromazine
In terminal phase of illness, treat with SC midazolam
When is cyclizine used in palliative care?
Nausea and vomiting in:
- Intracranial/intravestibular
- Gastrointestinal obstruction
- Movement disorders
When is domperidone used in palliative care?
Nausea and vomiting in context of gastric stasis
When is metoclopramide used in palliative care?
- Acute migraine
- Chemotherapy or radiotherapy induced N&V
- Gastric stasis (functional bowel obstruction)
Dopamine antagonist
When is ondansetron used in palliative care?
- Chemotherapy induced N&V
When is dexamethasone used in palliative care?
- Nausea related to ICP (add to cyclizine)
- Anorexia
- Spinal cord compression
- Liver capsule pain
When is levomepromazine used in palliative care?
- Chemically mediated N&V
- Visceral/serosal causes