Palliative Care/EOL

Question 1

Which prescription is appropriate for pain when EOL, if the patient has no pain relief already prescribed?

Answer 1

2.5-5mg Morphine SC PRN

Question 2

After initially prescribing morphine for EOL, when should the PRN dose be converted to a syringe driver?

Answer 2

If the patient requires 2 or more PRN doses in 24h

Question 3

What are some reversible causes of agitation with patients that are EOL?

Answer 3

Pain
Full bladder/rectum
Dyspnoea
Fear

Question 4

Which medication should be prescribed for Anguish/Anxiety in an EOL patient?

Answer 4

Midazolam 2.5-5mg SC Stat and PRN

Question 5

When should PRN anxiety medication be converted to syringe driver, and at what dose?

Answer 5

If the patient needs 2 or more PRN doses in 24h, convert to 5-10mg continual infusion

Question 6

Which medication should be prescribed for Psychosis/Dellusions in an EOL patient?

Answer 6

Levomepromazine 6.25-12.5mg SC PRN. Convert to syringe driver if needing 2 or more doses in 24h

Question 7

What general measures can help to improve symptoms of respiratory secretions in EOL patients?

Answer 7

Improve patient position - 30 degree incline

Stop artificial hydration

Question 8

Which medication should be prescribed for respiratory secretions in EOL, and at what dose?

Answer 8

Glycopyronium 200mcg SC stat then every 4h PRN

Question 9

When should you consider converting Glycopyronium from PRN to syringe driver in EOL?

Answer 9

If the patient needs 2 or more PRN doses in 24h, then convert to 600mcg via syringe driver`

Question 10

What should EOL patients be prescribed for Nausea and Vomiting?

Answer 10

Levomepromazine 2.5-5mg SC PRN

If needed twice or more, convert to 5-10mg via syringe driver

Question 11

If a patient is EOL and experiencing breathlessness, how can this be managed?

Answer 11

If already taking an opioid, titrate the dose up

If not taking an opioid, give Morphine 2.5-5mg SC

Question 12

How should glycaemic control be managed in an EOL patient that is T2DM?

Answer 12

Stop Metformin and Monitoring

Stop all analogues unless they need high dose insulin

Question 13

How should glycaemic control be managed in an EOL patient that is T1DM?

Answer 13

Give OD Insulin - Lantus/Tresiba
Check BMs OD at teatime
- <8mmol/L - Reduce insulin dose by 20%
- >20mmol/L - Increase insulin dose by 20%