Palliative Care Flashcards
Common symptoms of EoL
- pain
- N+V
- Secretions
- Agitation
- Resp distress
- Constipation
- Reduced appetite
- Fatigue
What are the contributors to ‘total pain’?
- Physical
- Psychological
- Social
- Spirtual
- Practical
WHO step ladder for analgesics
- Non-opioid +/- adjuvants
- Weak opioid +/- non-opioid +/- adjuvants
- Strong opioid +/- non-opoid +/- adjuvants
Look at slide for medication strength comparison
:)
How to dose morphine
Start with low dose with PRN doses for breakthrough pain
Reduce if frail/elderly
Then do PRN dose calculation
PRN dose calculation
Total background dose (total dose of day)
Divide by 6
Gives PRN dose that can have every 4 hrs
N+V therapies
Peppermint tea/oil
Ginger
Haloperidol 500mcg up to 2 hourly - also sedating effect
NG tube?
Antiemetic used in gastritis
Metoclopramide
Chemical causes of N+V antiemetic
Haloperidol
Anitemetic used for vestibular N+V
Cyclizine
Antiemetic used for raised ICP N+V
Cyclizine + dexamethasone
Antiemetic used for unknown/multifactorial/refractory N+V
Levomepromazine
Management of resp secretions
Glycopyronium bromide (200mcg S/C up to hourly)
Management of bowel secretions
Hyoscine butylbromide
Managing breathlessness in EoL
- Treat any underlying cause eg Pulmonary oedema
- Oxygen if hypoxaemic
- Opioids
- Benzodiazepines
Treatment for terminal agitation
Midazolam 2.5-5mg S/C up to hourly PRN
When is 10mg IV Midazolam prescribed?
Anticipatory medicine if high risk of haemorrhage
3 types of laxatives used in EoL constipation
Stimulant
Softener
Osmotic
DO NOT USE BULKING in EOL
Examples of stimulant laxatives
Bisacodyl
Senna
Sodium picosulfate
Examples of stool softners
Sodium docusate
Examples of osmotic laxatives
Laxido/Movicol
Order to give laxatives if taking multiple
Softner THEN stimulant - do not want to stimulate hard stool
