PALLIATIVE CARE Flashcards
Which opioids are preferred in severe CKD? And mild renal impairment?
Severe = Alfentanil, buprenorphine and fentanyl
Mild = oxycodone
If pain control is not adequate, how much should a dose of opioid be increased by?
30-50%
How should you manage respiratory secretions at the end-of-life?
- Reassure family - they are not in pain
- Hyoscine bromide (alpha-blocker/muscarinic antagonist) - 2 or more doses
- Review in 24 hours
What are the features of opioid toxicity?
reduced conscious level
slow respiratory rate
myoclonic jerks
pinpoint pupils
How do you convert doses of morphine to diamorphine?
Divide by 3
Give a risk factor for mucositis (painful ulceration of the mouth). How is it treated?
Radiotherapy to head/neck
Benzydamine hydrochloride mouthwash
Give 4 non-pharmacological approaches to managing nausea and vomiting.
- Control odours from colostomy, wounds and fungating tumours
- Minimise sight/smell of food
- Give small snacks not large meals
- Try acupressure wrist bands
What is the oral –> SC morphine conversion?
half the dose
What is the breakthrough dose of morphine?
1/6th daily morphine dose
What is the conversion from oral morphine –> IV?
divide by 3 e.g. 30mg PO = 10mg IV
What is the management of hiccups in palliative care?
chlorpromazine or haloperidol
What is the conversion of codeine –> morphine?
divide by 10
What are the indications of cyclizine?
+ RICP N&V
+ central causes
+ movement related
+ bowel obstruction
What are the indications for dexamethasone?
+ intracranial causes with headache (adjunct with cyclizine)
+ bowel obstruction
What are the indications and contraindications of domperidone?
+useful in gastric stasis
+ can be used in Parkinson’s
- not in bowel obstruction
