Palliative Care Flashcards
What are 4 common symptoms patients need treated in palliative care?
Pain/SOB
Distress
Nausea
Secretions
How do you treat pain/SOB in palliative care?
2mg Morphine SC hourly
How do you treat distress in palliative care?
2mg Midazolam SC hourly
How do you treat nausea in palliative care?
2.5mg Levomepromazine SC hourly
How do you treat secretions in palliative care?
20mg Buscopan SC hourly
How do you manage mild pain in palliative care?
- 1g Paracetamol 4x daily
- And/Or 500mg NSAID 2x daily
- And/or Adjuvant
How do you manage moderate pain in palliative care?
- 30-60mg Codeine 4x daily OR 2 Co-codamol 30/500 tablets daily
- And/Or Adjuvant
How do you manage severe pain in palliative care?
- Stop Codeine
- Switch to 10-15mg M/R Morphine Sulphate 2x daily WITH 5mg I/R Morphine Sulphate PRN hourly
- Titrate up the M/R morphine sulphate depending on the dose of I/R morphine sulphate given
- Can use Paracetamol/NSAID/Adjuvant in conjunction
Why is there a need for Modified Release (M/R) and Immediate Release (I/R) morphine sulphate?
Patients can experience 2 types of pain:
- Background pain (exactly what it says it is) which is treated with M/R morphine sulphate
- Breakthrough pain (flare-ups of background pain that are more severe) which is treated with I/R morphine sulphate
Give examples of M/R morphine sulphate
Zomorph
MST
(different brands but same drug)
Give examples of I/R morphine sulphate
Sevredol (tablet form)
Oramorph (liquid form)
What must you do prior to titrating up morphine?
Check the patient’s pain levels
While there is no max. dose for morphine, titrating up without checking the patient’s pain levels leads to morphine accumulation and side effects
What factor influences the type of adjuvant chosen?
Type of pain the patient is experiencing
E.g. if patient is experiencing MSK pain, then the adjuvant will be NSAID but if the pain is Neuropathic, the adjuvant will be Gabapentin/Pregabalin
What are side effects of morphine toxicity?
Hallucinations
Vivid dreams
Drowsiness
Myoclonus (sudden jerking movement, often seen in sleep)
How can side effects of morphine toxicity be treated?
Either by:
- Reducing morphine dose
- Switching to another opioid drug
SEEK ADVICE BEFORE DOING EITHER
What happens if morphine toxicity is not detected early?
Progress to respiratory depression, which is a medical emergency
How can morphine-induced respiratory depression be treated?
Naloxone - reverses morphine effects
Can morphine be withdrawn suddenly?
No, only gradually.
Otherwise, patient will experience morphine withdrawal and pain, resulting in severe distress
What must be checked prior to morphine administration?
Renal function, as morphine is excreted renally
What will happen if morphine is administered in the case of an AKI?
Morphine accumulation leading to toxicity
SEEK ADVICE IN CASES OF AKI
Are all opioid drugs equal?
No, opioid drugs have different potencies to each other.
E.g. Oxycodone is 2x stronger than morphine so half the morphine dosage is given
Does administration route of opioid drugs matter?
Yes
E.g. SC is 2x stronger than oral administration so to find the SC dose, half the total daily oral dosage
What muscular function weakens as part of the dying process?
Swallowing, hence why mouth hygiene and care is vital in palliative care
What is artificial hydration?
A means of giving food and fluid to a patient by routes other than oral intake
When is artificial hydration conducted?
When the patient is in distress from thirst/dehydration DESPITE good mouth care and hygiene
What is a syringe driver?
A device which provides continuous SC infusion of up to 3 medications to a patient when oral intake is no longer available.
