Palliative Care Flashcards
Management of breathlessness
Morphine 1mg PO PRN/sustained release 5mg BD
Short acting Benzos- lorazepam 0.5mg
Types of laxatives and their uses
Bulking agents- fybogel- fibre- not used in poor intake or poor bowel
Stimulant- Senna- not used in obstruction or colonostomy
Osmotic-pull water in- lactulose, movicol
When to give ondansetron
Chemo
Abdo Radio
Abdo surgery
When to give cyclizine
Central vomiting
CNS lesion
Labrythnitis
When to give Metoclopramide
Delayed GIT transit
Bowel obstruction
When to give Haloperidol
Chemical causes
Renal failure
Drug causes
SE of ondansetron
Constipating
QT prolongation
Haloperiol SE
Parkinsons
Lower seizure threshold
Metoclopramide SE
Parkinsons
Cardiac
young women- movement disorders
Conversion of tramadol to morphine oral
/10
Any step 2 to Morphine
Oral morphine to SC morphine (SYRINGE)
/2
Oral morphine to oral oxycodone
/2
Immediate to Modified release for morphine
Convert to BD
Same for oxycodone
Calculating PRN doses
Calculate daily dose
PRN =daily/6
What to usually co prescribe with opioid
Anti emetic
Laxative
Which opioids are safe in renal failure
Fentanyl
Alfentanil
Buprenorphine
Common symptoms in patients in last hours/days to live
Pain and breathlessness
N+V
Agitation anxiety
Respiratory secretions
Prescription for symptoms for last hours to live
Morphine- 2.5-5 SC 1-2hrs PRN - pain
Midazolam- “- agitation
Glycopyrronium- 0.2-0.4 SC QDS PRN- secretions
Haloperidol 0.5-1.5 SC BD PRN - N+V
Preferred opioid in palliative care
Diamorphine
Increasing pain treatment
Increase by 1/3rd if pain not 90% received
Mx of hiccups
Chlorpromazine
Tx of secretions
Hyoscrine 1st
Glycopyyronium
Tx of agitation and confusion
Haloperidol
Chlopromazine
Terminal restlessness- midazolam
What should you increase morhpine by if not controlled
30-50%
If mild renal impairment and SOB and pain what should you give
Oxycodone
If on high doses of pain killer with metastatic disease pain not controlled what can you do next
If spinal cord involvement- dex
If no- radio, bisphosphonates
Morphine to diamorphine SC
Divide by 3
Treatment of bowel colic
Hyoscrine
Tx of mouth pain in end of life
Benzydamine Hydrochloride
