Palliative Care

Question 1

What drugs should be anticipatory prescribed for EoL care?

Answer 1

Pain - morphine (Zomorph) 20mg SC PRN
Anxiety - midazolam 2.5 - 5 mg SC PRN
Secretions - glycopyronium 200 mg SC PRN
Nausea - levomepromazine or Haloperidol SC PRN

Question 2

What pharmacological options are available for the treatment of anorexia?

Answer 2

Corticosteroids
Progestogens
Prokinetics e.g. metoclopramide

Question 3

What interventional treatments are available for Bowel obstruction in palliative care?

Answer 3

Intraluminal scenting
NG tube
Venting Gastrostomy

Question 4

What are the contraindications to a venting gastrostomy?

Answer 4

Coexisting ascites and presence of peritoneal disease.

Question 5

How can you medically manage malignant Bowel obstruction?

Answer 5

Analgesia - morphine
Antisecretory agents - ocreotide
Steroids - reduce gut wall oedema
Antispasmodic anticholinergics - hyoscine butylbromide

Question 6

What is ocreotide and how does it work?

Answer 6

Somatostatin analogue that inhibits VIP in the gut.
Reduces gastric and pancreatic juices, water and electrolyte secretion in the lumen.
Reduces splanchnic blood flow, indirectly decreasing gut wall oedema, peristalsis and bile excretion

Question 7

Why should IV fluids be administered cautiously in case of malignant BO, if at all? What would be the alternative?

Answer 7

May induce third spacing and abdominal distension.

Thirst is best addressed with good mouth care.