Palliative care Flashcards
Which Benzo for breathlessness
Lorazepam 0.5mg PRN SL
-> short acting benzo
Which laxative would you avoid in palliative care and why?
bulk forming diuretics
can’t use with poor oral intake or poor bowel motility
Summarise the different types of laxatives
- softening agents -> lubricate the stool (e.g. liquid paraffin/milpar)
- bulking agents -> increase faecal mass stimulating peristalsis (e.g. Bran, fybogel)
- stimulant agents -> increase intestinal motility (e.g. senna or bisacodyl)
- osmotic agents -> pull liquid into stool (e.g. macrogol)
What are the common symptoms at the end of life?
pain
agitation/distress/anxiety
respiratory tract secretions
breathlessness
N&V
PC management of breathlessness
- treat reversible cause
- oxygen if hypoxic
- morphine sulfate immediate release 1mg PO PRN / sustained release 5mg BD
- manage anxiety component with therapies, mindfulness etc or: LORAZEPAM 0.5 mg PRN SL
-> short acting benzo
Which antiemetic for central causes?
main SE
cyclizine
irritant SC
severe HF - avoid
Which antiemetic post chemo/abdo surgery / abdo radiotherapy?
main SE
ondansetron
-> very constipating, QT prolongs
Which antiemetic for chemical causes?
chemical causes = renal failure, drug induced, acid base imbalance..
Haloperidol
Risks: lowers seizure threshhold, avoid in Parkinsons
Which antiemetic for delayed GIT transit/obstruction without colic?
metoclopramide / domperidone
risks:
BO with colic
Parkinsons
cardiac conduction disorders
young women - SE movement disorders
3rd line antiemetic for all causes
levopromazine
risks: long half life, sedating, lowers seizure threshold, severe HF, CVD and PD
Which opioids are safe in renal failure
buprenoprhine
fentanyl
alfentanyl
Common anticipatory medications
PAIN
- morphine sulfate
(oxycodone alternatively)
SECRETIONS
Glycopyrronium
(alt: hyoscine butylbromide, butylbromide (buscopan))
AGITATION/DISTRESS
- Midazolam
BREATHLESSNESS
- Midazolam
or
- Morphine
N&V
- Haloperidol
(alt: cyclizine)
What is never the correct route in palliative care?
IM