palliative care Flashcards
which opioid do you always start with for palliative pain management?
morphine sulfate
in WHICH cases would you not use morphine sulfate?
renal impairment
starting does of cyclizine?
50 mg
signs of opioid toxicity?
- myoclonus
- hallucinations
- drowsiness
- slurred speech
- pinpoint pupils
- plucking at the sheets
morphine sulfate slow release onset and duration?
4 hours and 12 hours
morphine sulfate immediate release onset and duration?
15-45 minutes, 4 hours
what eGFR should morphine sulfate be avoided in?
<50
oxycodone use should be avoided in…
hepatic impairment
why should oxycodone be avoided in hepatic impairment?
metabolites accumulate
which is more potent, oxycodone or morphine sulphate?
oxycodone is twice as potent
can oxycodone be giving with a morphine allergy?
yes
what is the opioid PRN dose?
1/6 the total regular dose in 24 hours
when should you increase the opioid dose?
when a patient requires 3 or more PRN doses in 24 hours
how much should you increase an opioid dose by?
33-50%
subcutaneous opioid is ___ as potent as PO?
twice
how do you calculate a subcutaneous opioid dose?
divide the PO dose by 2
when would you give subcutaneous opioids?
when patient is vomiting, too drowsy, dying
indications for opioid transdermal patches?
- poor oral intake
- poor compliance
- renal impairment
which drugs are used for end of life nauseau?
- cyclizine
- haloperidol
why do patients at end of life have increased resp secretions?
-inability to cough effectively or swallow and clear secretions
how to manage secretions at end of life?
-hyoscine SC
how do increased secretions present at end of life?
a rattling or gurgling sound
how to manage agitation at end of life?
- midazolam
- haloperidol (avoid in parkinsons)
how to try dry mouth at end of life?
artifical saliva
