Palliative care Flashcards
managing agitation and confusion
treat underlying cause
haloperidol
chlorpromazine, levomepromazine
if terminal - midazolam
managing hiccups
chlorpromazine
haloperidol
gabapentic
dexamethasone if hepatic lesions
causes of nausea and vomiting in palliative care patients
reduced gastric motility - due to opioids
chemical - due to hypercalcaemia, opioids, or chemotherapy
visceral/serosal - due to constipation
raised ICP - due to cerebral mets
vestibular - activation of Ach and H1 receptors in opioid use
cortical - due to anxiety, pain
treating N/V due to reduced gastric motility
Pro-kinetic agents to reduce gastric dysmotility and stasis
metoclopramide, domperidone
do not use if prokinesis may negatively affect GI tract e.g., in bowel obstruction
treating chemically mediated N/V
correct chemical disturbance
treat with ondansetron, haloperidol, levomepromazine
treating N/V due to visceral/serosal causes
Cyclizine and levomepromazine are first-line
Anti-cholinergics such as hyoscine can be useful
treating N/V due to raised ICP
cyclizine
dexamethasone
treating N/V due to vestibular causes
cyclizine
treating N/V due to cortical causes
short acting benzo, lorazepam
cyclizine
starting pain treatment in palliative care
regular oral modified-release (MR) or oral immediate-release morphine - 20-30mg MR
oral immediate-release morphine for breakthrough pain - 5mg (oral >patches)
give laxatives
counsel re nausea and drowsiness
SIGN guidelines
breakthrough dose of morphine is one-sixth the daily dose of morphine
patients who receive opioids should be prescribed a laxative
use opioids with caution if with CKD - oxycodone preferred if renal impairment
increasing opioid doses
each dose increase should be by 30-50%
other pain medication used to manage palliative pain
In addition to strong opioids, bisphosphonates and radiotherapy, denosumab may be used to treat metastatic bone pain.
conversions in opioid medication
oral codeine/tramadol to oral morphine - divide by 10
oral morphine to oral oxycodone - divide by 1.5-2
morphine oral to SC - divide by 2
morphine oral to SC diamorphine - divide by 3
oral oxycodone to SC diamorphine - divide by 1.t
managing excess secretions in palliative care
Avoiding fluid overload
hyoscine hydrobromide or hyoscine butylbromide (less sedative)
glycopyrronium bromide