Palliative care Flashcards
When converting oral morphine to SC, what calculation should you do?
Divide by 2
When starting pain relief in palliative care, what is the initial dose of morphine for patients with no comorbidities?
20-30mg of modified-release morphine (MR) a day, with 5mg of immediate-release morphine for breakthrough pain.
How would you calculate the breakthrough dose of morphine?
1/6th of daily morphine dose
Which opioid is preferred in palliative patients with mild-moderate renal impairment?
Oxycodone
Which opioids are preferred in palliative care patients with severe renal impairment?
Buprenorphine or fentanyl - as they’re not renally excreted and therefore less likely to cause toxicity.
When increasing the dose of opioids, how much should the next dose be increased by?
30-50%
What are the main side effects from opioids?
- Transient: nausea, drowsiness.
- Persistent: constipation.
How would you convert from oral codeine to oral morphine?
Divide by 10
What is the first line anti-emetic for raised ICP?
Cyclizine
Management of agitation and confusion in palliative patients?
- First-line: haloperidol.
- Terminal phase of illness: midazolam.
Metastatic bone pain may respond to…
Analgesia, bisphosphonates or radiotherapy
When would dexamethasone be used?
Metastatic spinal cord compression or raised ICP
List the commonly used drugs in palliative care ‘anticipatory meds’ and their indications
- Nausea and vomiting: cyclizine, levomepromazine, haloperidol, metoclopramide.
- Respiratory secretions/bowel colic: hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide.
- Agitation/restlessness: midazolam, haloperidol, levomepromazine.
- Pain: diamorphine is the preferred opioid.
- SOB: opioids.
What symptoms might a patient experience towards the end of life?
- SOB
- Pain
- N+V
- Chest secretions
- Agitation/anxiety
What is the role of a hospice?
- End of life care
- Symptom management (2 weeks)
