Palliative Care Flashcards
What drugs are used for treatment of pain in palliative care?
Opioids: morphine, fentanyl, oxycodone, methadone
Which opioids can be used in renal impairment?
Fentanyl and methadone.
Why can’t morphine be used in renal impairment?
Morphine is renally excreted. Renal impairment can cause the build up of morphine metabolites which can contribute to nephrotoxicity.
How is breakthrough morphine liquid dosing calculated?
1/6th of total daily morphine dose
What are the adverse effects of opioids and how are they managed?
Constipation –> laxatives
Nausea vomiting –> antiemetics but usually resolves in a few days
Drowsiness –> lasts 2-3 days
Hallucinations –> decrease dose, switch opioid, haloperidol
Itch –> decrease dose, switch opioid, antihistamine.
How is constipation managed in palliative care?
Laxsol (as much as necessary). Can add on macrogol (molaxole sachets) if not controlled with laxsol.
What is the mechanism of opioid-induced constipation?
Opioids bind to the mu receptors in the gut, decreasing peristalsis and causing increased GI transit time. This causes more water be reabsorbed from the stool.
Morphine, oxycodone MOA?
Binds to opioid receptors to inhibit the ascending pain pathways.
Fentanyl MOA?
Binds to receptors in the CNS to inhibit the ascending pain pathways.
Laxsol MOA?
Laxsol contains docusate, which is an osmotic laxative that draws water into the stool, and senna, which is a stimulant.
Haloperidol MOA?
Binds to postsynaptic dopaminergic receptors in the brain.
Levopromazine MOA?
Binds to and inhibits all receptors in the CNS (dopamine, muscarinic and 5-HT) to bring about the inhibition of vomiting.
How is shortness of breath managed in palliative care?
Nebulised bronchodilators (ipratropium, salbutamol)
Opioids (morphine)
Anti-anxiety medication (midazolam, lorazepam)
