Palliative Care Flashcards
Palliative care agitation and confusion?
- 1st line = Haloperidol
- 2nd line = Chlorpromazine, levomepromazine
Terminal agitation and restlessness?
Midazolam
Starting palliative pain regimen?
20-30mg Modifified release morphine + 5mg for breakthrough pain
Breakthrough dose of morphine?
1/6th the daily dose
Opioid choice in mild-moderate CKD?
Oxycodone
Severe renal impairment painkiller?
- Alfentanil
- Buprenorphine
- Fentanyl
Metastatic bone pain Rx?
- Strong opioids
- Bisphosphonates
- Fentanyl
- Radiotherapy
- Denosumab
How much to increase dose of opioids by?
30-50%
Transient opioid s/e?
Nausea and drowsiness
Persistent opioid s/e?
Constipation
Oral codeine to oral morphine?
Divide by 10
Oral tramadol to oral morphine?
Divide by 10
Oral morphine to oral oxycodone?
Divide by 1.5-2
Transdermal 12 mcg fentanyl patch morphine equivalent?
30mg oral morphine daily
Transdermal 10mcg buprenorphine patch equivalent?
24mg oral morphine daily
Oral morphine to subcutaneous morphine?
Divide by 2
Oral morphine to subcutaneous diamorphine?
Divide by 3
Oral oxycodone to subcutaneous diamorphine?
Divide by 1.5
Palliative hiccups management?
- Chlorpromazine for intractable hiccups
- Haloperidol, gabapentin also used
- Dexemethasone particularly used if hepatic lesions
6 Palliative care N&V syndromes?
- Reduced gastric motility = opioid related
- Chemically mediated = hypercalcaemia, opioids, chemo
- Visceral/serosal = constipation, candidiasis
- Raised ICP = cerebral metastases
- Vestibular = opioid related
- Cortical = anxiety, pain, fear and/or anticipatory nausea
Reduced gastric motility nausea and vomiting Rx?
Metoclopramide and domperidone (prokinetics)
Chemically mediated nausea and vomiting Rx?
Ondansetron, haloperidol, levopromazine
Visceral/serosal nausea and vomiting causes?
Cyclizine and levopromazine
Raised ICP N&V Rx?
Cyclizine, Dexamethasone, Radiotherapy
Vestibular N&V Rx?
- Cyclizine
- Prochlorperizine/metoclopromide
- Olanzapine/risperidone in refractory cases
Cortical N&V Rx?
- Lorazepam if anticipatory
- If BZDs not ideal, try cyclizine
- Can try ondansetron and metoclopramide