Palliative and End of Life Care

Question 1

What is deprescribing?

Answer 1

In palliative care, stopping any medicines which do not provide immediate benefit.

Question 2

What are anticipatory medicines?

Answer 2

Medicines which are prescribed in advance to enable rapid relief of predictable distressing symptoms.

Question 3

What is a syringe driver?

Answer 3

A machine which administers medicine subcutaneously slowly over 12 or 24 hours.

Question 4

What are the advantages of using a syringe driver?

Answer 4

Avoids regular injections so more comfortable.
Gives dose continuously over 12/24 hours so no peaks and troughs in plasma levels.
Medicines can be mixed and given together at the same time.
Can be portable.
Good for patients who cannot swallow or are vomiting often.

Question 5

What are the disadvantages of using a syringe driver?

Answer 5

Not all medications can be delivered subcutaneously. If incompatible, medicines may appear cloudy or as crystals.
Nurses required for administration and must be adequately trained.
Risk of infection at site of entry

Question 6

What are some symptoms anticipatory medicines might be prescribed for?

Answer 6

• Anxiety and agitation
• Breathlessness .
• Nausea and vomiting
• Noisy respiratory secretions
• Pain
• Constipation
• Cough

Question 7

How can anxiety and agitation be treated in palliative care?

Answer 7

Levomepromazine for delirium and agitation
Midazolam for anxiety.

Question 8

How can breathlessness be treated in palliative care?

Answer 8

Identify and treat reversible causes of breathlessness such as pulmonary oedema or pleural effusion.
Breathlessness can be treated with opioids as the side effect of respiratory depression can decrease respiratory rate. PO morphine 5-10mg every 4h prn.

Question 9

How can noisy respiratory secretions be treated in palliative care? What monitoring is required?

Answer 9

Hyoscine hydrobromide
Monitor for side effects such as delirium, agitation, or excessive sedation.

Question 10

How can constipation be treated in palliative care?

Answer 10

Laxatives depending on cause. Generally, try a stimulant such as senna.

Question 11

How can a cough be treated in palliative care?

Answer 11

Weak opioid cough suppressant such as pholcodine linctus or codeine linctus. Switch to morphine if necessary