Palliative Care Flashcards
Describe the pain management ladder?
Paracetamol 1g qds +/- NSAID or other adjuvant
Codeine 30-60mg qds +/- paracetamol or other adjuvant
Morphine +/- adjuvant
Morphine is not usually addictive if used properly, but patients will become what?
What is the most severe effect of morphine use?
What can be used to reverse the above side effect?
What are some symptoms of opioid toxicity?
How should opioid toxicity be treated?
Opioid tolerant
Respiratory depression
Naloxone
Hallucinations, myoclonus, drowsiness
Adjust dose or change medication
What are the two forms of morphine and when is each given?
Modified release, given twice daily for background pain
Immediate release, given as required for breakthrough pain (can be tablet or liquid)
How much stronger than codeine is morphine?
What happens to the potency of morphine when given SC?
Ten times
It is twice as potent, so divide the PO dose by 2
What are some conditions which can mimic dying, that you should be aware of if a patient was to deteriorate suddenly?
Opioid/drug toxicity
Sepsis
Hypercalcaemia
AKI
Hypoglycaemia
What is the smoothest way of giving medications in palliative care?
How many medications can be used together this way? How often does it need to get changed?
What is a common cause of agitation in palliative patients that you should try not to miss?
Should routine obs be continued?
Continuous SC infusion with a syringe driver
3 - infused over 24 hours so change daily
Urinary retention
No
What is the main anticipatory medication for each of the following:
Pain/SOB?
Distress?
Nausea?
Secretions?
Morphine
Midazolam
Levomepromazine
Buscopan
