Palliative Care Flashcards
First line treatment for secretions in end of life?
Hyoscine hydrobromide or hyoscine butylbromide is generally used first-line to manage secretions in a palliative care setting.
Glycopyrronium bromide is also commonly used however is typically considered a second-line option.
Opioid analgesia of choice in patient’s with mild-moderate renal impairment?
Oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment. It is mainly metabolised in the liver, reducing the risk of opioid toxicity.
Alfentanil, buprenorphine and fentanyl are also the preferred opioids in patients with chronic kidney disease.
How to calculate the dose of breakthrough dose for morphine?
The breakthrough dose of morphine is one-sixth the daily dose of morphine.
Converting dose of oral codeine to morphine?
In general, patients should be converted to a modified-release (MR) morphine regimen (with PRN breakthrough cover) when possible as this reduces the number of doses required over a 24-hour period. To convert codeine to morphine you divide by 10. T
Example if patient’s total codeine dose is 176mg (44mg QDS) and they therefore require 17.6mg of morphine. Divided into two doses this is 8.8mg of morphine twice a day.
Converting dose from oral morphine to subcutaneous morphine?
Divide by two for oral to subcutaneous morphine conversion
Example: Pt is having a total of 120 mg of morphine over 24 hours currently via an oral route.
Therefore the correct dose of subcutaneous morphine over 24 hours is 60 mg.
Drug of choice for hiccups?
Chlorpromazine is a first-generation antipsychotic drug that has been shown to be effective in the treatment of intractable hiccups, particularly in patients with advanced cancer.
Haloperidol and gabapentin are also used.
Pharmacological treatment for headache caused by raised ICP?
Dexamethasone.
Headache caused by raised intracranial pressure due to brain cancer or metastases can be palliated with dexamethasone by reducing cerebral oedema and therefore, reduce intracranial pressure, help alleviate symptoms of headaches and improve associated neurological deficits.
