Palliative Care

Question 1

Nausea in palliative patients

Answer 1

GI: constipation, bowel obstruction, think of hypercalcemia as a potential reversible cause
Psychological
Intracranial :tumour or pressure
Medications e.g. chemo/radiotherapy

(ref: palliative care expert group 2010, end of life check 2017)

Question 2

1/ Causes of Dry Mouth

2/Non pharmacological mx of dry mouth

Answer 2

1/radiotherapy
chemotherapy
medication - antipsychotics, anti-depressants, anti-Parkinsonian, anti-Hypertensives, opioids
medical condition - alzheimer’s
terminal stages of disease
mouth breathing related to disease and/or stage of illness
oxygen therapy.

2/ chewing gum 
water sips 
mouthwashes with water or water with sodium bicarb 
pineapple chunks, froze lemon slices 
sprays and gels 
lip balm 
(ref: RACGP end of life check)

Question 3

When is a syringe driver considered

Answer 3

• persistent nausea and vomiting • dysphagia
• bowel obstruction
• coma					
• poor absorption of oral drugs					
• patient preference. 
(ref: RACGP end of life check)

Question 4

Sx of dying and medications: 
1/ Nausea
2/ Pain 
3/ Delerium 
4/ Respiratory secretions 
5/ Dry mouth
6/Bowel and bladder

Answer 4

1/ Metoclopramide 10mg s/c / Domeperidone can only be given orally
2/ Morphine 2.5-5mg s/c QID PRN
3/ Ensure not full bladder or fecal 3/ impaction/ Haloperidol 0.5mg s/c QID PRN
–> Note 30% of patients with delirium will
not respond adequately to anti psychotic
–> clonazepam drops [2-6drops PRN]
–> midazolam in syringe driver
4/ hyoscine butylbromide [20mg s/c PRN QID]
5/ non pharmacological (e.g. clean dentures BD, oral swabs, water with sodium bicarb, artificial saliva, lip balm)
(ref: RACGP end of life check)

Question 5

Side effects of
1/ metoclopramide
2/ domperiodone?

Answer 5

1/ in renal failure → accumulates → extra pyrimidal side effects
2/ prolonged QT interval
(ref: RACGP end of life check)