Palliative Care 20/7 Flashcards
Non-pharmacological management strategies of nausea/vomiting
- Control odours from colostomy, wounds and fungating tumours
- Minimise sight/smell of food
- Give small snacks not large meals
- Try acupressure wrist bands
Pharmacological management of chemical causes of nausea + vomiting e.g. opioids
haloperidol
- acts on D2 dopamine receptors
OR metoclopramide
- act on D2 and 5HT receptors
Pharmacological management of gastro causes of nausea+ vomiting e.g. gastric stasis
metoclopramide/domperidone
- act on D2 and 5HT receptors
Pharmacological management of non-specific/multi-factorial causes of nausea + vomiting
prochlorperazine/levomepromazine
- act on D2, H1 and ACh receptors
Pharmacological management of histaminergic causes of nausea + vomiting
cyclizine/promethazine
- act on central and peripheral H1 receptors
Examples of histaminergic causes of N+V
- obstruction
- peritoneal irritation
- vestibular causes (motion sickness)
- raised intra-cranial pressure
Pharmacological management of radio/chemotherapy-induced nausea + vomiting
granisetron, ondansetron
- act on 5-HT3-receptors
Pharmacological management of spasmodic causes of nausea + vomiting
hyoscine butylbromide (buscopan)
- antispasmodic that acts on ACh receptors (antimuscarinic)
- indicated for IBS, bladder cramps and period pain
cough suppressant (antitussive) medications in palliative care
- codeine
- morphine (COPD/malignancy)
- glycerol (soothing barrier)
titration options for starting morphine/strong opioid
- Prescribe the dose on a four hourly as required PRN basis (this relies on the patient asking for pain relief)
- Prescribe the dose on a regular basis every four hours (patient receives pain relief without needing to request it)
For both methods assess the patient’s pain after 24 hours.
If effective change to BD modified relief
breakthrough pain PRN dose
1/10th to 1/6th of the equivalent total daily dose of the drug is recommended
opioid adverse effects
- N+V co-prescribe a suitable antiemetic, switch opioid if needed.
- Constipation co-prescribe a softening and stimulant laxative
- Cognitive impairment, drowsiness, myoclonic jerks, dysphoria and respiratory depression
- Urinary retention, may be resolved by dose reduction or opioid switch.
- Dry mouth
- Sweating
- Hallucinations
indications for a syringe driver
- Patient unable to take medication orally
- Poor absorption of oral medication (N+V, oedema)
- Intestinal obstruction
syringe driver battery charge required for 24hrs
35%
signs of imminent death (palliative)
- increasing frailty
- difficulty swallowing (last days/hours)
- withdrawal (more sleeping, confusion in last days)
- circulatory changes (cold/pale extremities, low BP)
- breathing changes (Cheyne-Stokes breathing/rattling - last days)
- sudden event (PE/MI/stroke)