Palliative care Flashcards
Drugs for pain/breathlessness
Diamorphine
Morphine
Drugs for nausea/vomiting
haloperidol +/- cyclizine +/- metoclopramide
Drug for agitation
Midazolam
Drug for hallucinations
Haloperidol
Drugs for secretions
Hyoscine butyl bromide
Hyoscine hydrobromide
How long do you listen to heart for to confirm death?
2 mins
How long do you listen to lungs for to confirm death?
3 mins
Which drug should not be given with cyclizine?
Metoclopramide
WHO pain ladder and examples at each stage
1 = non-opioid analgesics (paracetamol)
2 = weak opioids (codeine, tramadol, dihydrocodeine)
3 = strong opioid (morphine, oxycodone, fentanyl)
Prescribing pathway for bone pain
1= radiotherapy
2 = adjuncts (analgesic ladder)
3 = biphosphonates
Medications for neuropathic pain
Amitriptyline and pregabalin
How to calculate breakthrough pain dose
Add up total background dose and divide by 6
If going from oral to subcut morphine how do you change dose?
/10
If going from oral morphine to oral oxycodone how do you change dose?
Half it
If going from oral morphine to oral codeine + weak opioid how do you change dose?
Divide by 10
Treatment for oral irritation
Cyclizine
Treatment for post-surgery nausea
Ondansetron
What kind of sickness can you use ondansetron for?
Acts on chemoreceptors - chemotherapy sickness
What kind of sickness can you use cyclizine for?
Acts centrally on chemoreceptor transmission zone, use for brain mets
What kind of sickness do you use dexamethasone for?
If raised ICP
What sickness do you use haloperidol for?
chemical imbalance - raised calcium
What kind of sickness do you use metoclopramide for?
Gastric stasis (not obstruction)
How do you treat breathlessness?
Midazolam/morphine
Which drugs can you not mix with water for injection?
OK - ketamine, ketorolac, ocreotide, ondansetron
Starting dosing for oral morphine?
20-30mg + 5mg breakthrough
What must you prescribe with opioids?
laxative
When do you prescribe oxycodone instead of morphine?
Renal impairment
Transient and permanent sx of opioid use
nausea and constipation
What do you use for EOL mouth pain?
benztdamine hydrochloride mouthwash
Convert oral codeine to oral morphine
/10
Convert oral tramadol to oral morphine
/10
Convert oral morphine to oral oxycodone
/1.5
Convert oral morphine to sc morphine
/2
convert oral morphine to sc diamorphine
/3
convert oral oxycodone to sc diamorphine
/1.5
