Palliative care Flashcards
Pain Mx in palliative care
Mild pain: Paracetamol or oral NSAID
Moderate pain: Weak opioid e.g. codeine, tramadol (avoid in elderly)
Severe pain: Oral morphine 1st-line (alternatives include transdermal fentanyl, transdermal buprenorphine, oral oxycodone)
Transdermal analgesia is not suitable for acute pain
Morphine prescribing for pain relief
Normally given oral Immediate or Modified Release - MR is the same dose as IR but BD
Breakthrough dosing: Prescribe PRN breakthrough dose 1/6 of daily dose
SC morphine in syringe driver is 2x as potent as oral morphine, so add up total morphine dose per day including breakthrough doses, divide by 2 and that is the total dose over 24h, to be given in 2 12-hourly doses
Neuropathic pain options
Pregabalin, Gabapentin
Nerve compression = Dexamethasone
When is oxycodone used
Generally for non-opioid naive patients, who are already receiving an opioid or cannot tolerate morphine
Symptom control: Anorexia
Prednisolone/dexamethasone
Symptom control: Bowel colic/excessive secretions
Hyoscine/Glycopyrronium
Symptom control: Capillary bleeding
Tranexamic acid
Symptom control: Constipation
Lactulose + senna Methylnaltrexone bromide (opioid induced palliative constipation)
Symptom control: N+V
If due to opioid therapy: Haloperidol or metoclopramide
Metoclopramide (gastritis, mechanical bowel obstruction w/o colic - DON’T give if complete BO)
Don’t use in conjunction with antimuscarinics
Haloperidol (Metabolic causes e.g. hypercalcaemia)
Cyclizine (mechanical bowel obstruction, motion sickness)
Ondansetron (only post-chemo, radiotherapy or abdo surgery)
Symptom control: Dyspnoea
Dyspnoea at rest: Oral morphine
Dyspnoea associated with anxiety: Diazepam
Symptom control: Cough
Oral morphine
Symptom control: Agitation
Midazolam
