Palliative care Flashcards
what is an advanced care plan
key info summary in scotland
created by GPs and shared with others but info about CPR, preferred place of death or care and anticipatory meds
who should be offerred an ACP/KIS
life limiting illness at risk of decline
what is the standard morphine prescription ofr cancer pain
12hr M/R BD morphine with 1/6th dose PRN 4hr morphine for breakthrough pain
titrate up M/R if needed
no max dose but watch toxicity and consider other pain relief
mild symptoms of opioid toxicity
hallucination, myoclonus, drowsy
severe symptom opioid toxicity and management
respiratory depression
naloxone in small IV doses to prevent toxicity but avoid pain reversal
how does AKI lead to opioid toxicity
excretion is impaired
what is the generally most accepted second line opioid to morphine in palliative care and how does dosing change
oxycodone
half the dose
what opiates are safest in renal impairment
alfentanil
fentanyl
signs of a palliative patient who is dying
worsening weakness progressive fatigue and unconscious lost interest in food and drink cheyne stokes breathing should all be progressive and in context of advanced disease
treatalble conditions mimicking dying?
opioid toxicity sepsis infection hypercalcaemia AKI hypoglycaemic
how to maintain comfort and dignity in a dying patient?
essential meds only oral converted to alternative if no swallow anticipatory meds stop obs and unused cannulas appropriate environment support and updates to family
what is a syringe driver, how long does it last, how many meds can it give
subcut infusion of meds over 24 hours when oral route not possible
3 meds together
anticipatory drugs - pain/SOB
morphine 2mg SCUT hourly or approx 1/6th dose if established
anticipatory drugs - distress
midazolam
anticipatory drugs - nausea
levomepromazine
