Palliative Care/EOL Flashcards
Which prescription is appropriate for pain when EOL, if the patient has no pain relief already prescribed?
2.5-5mg Morphine SC PRN
After initially prescribing morphine for EOL, when should the PRN dose be converted to a syringe driver?
If the patient requires 2 or more PRN doses in 24h
What are some reversible causes of agitation with patients that are EOL?
Pain
Full bladder/rectum
Dyspnoea
Fear
Which medication should be prescribed for Anguish/Anxiety in an EOL patient?
Midazolam 2.5-5mg SC Stat and PRN
When should PRN anxiety medication be converted to syringe driver, and at what dose?
If the patient needs 2 or more PRN doses in 24h, convert to 5-10mg continual infusion
Which medication should be prescribed for Psychosis/Dellusions in an EOL patient?
Levomepromazine 6.25-12.5mg SC PRN. Convert to syringe driver if needing 2 or more doses in 24h
What general measures can help to improve symptoms of respiratory secretions in EOL patients?
Improve patient position - 30 degree incline
Stop artificial hydration
Which medication should be prescribed for respiratory secretions in EOL, and at what dose?
Glycopyronium 200mcg SC stat then every 4h PRN
When should you consider converting Glycopyronium from PRN to syringe driver in EOL?
If the patient needs 2 or more PRN doses in 24h, then convert to 600mcg via syringe driver`
What should EOL patients be prescribed for Nausea and Vomiting?
Levomepromazine 2.5-5mg SC PRN
If needed twice or more, convert to 5-10mg via syringe driver
If a patient is EOL and experiencing breathlessness, how can this be managed?
If already taking an opioid, titrate the dose up
If not taking an opioid, give Morphine 2.5-5mg SC
How should glycaemic control be managed in an EOL patient that is T2DM?
Stop Metformin and Monitoring
Stop all analogues unless they need high dose insulin
How should glycaemic control be managed in an EOL patient that is T1DM?
Give OD Insulin - Lantus/Tresiba
Check BMs OD at teatime
- <8mmol/L - Reduce insulin dose by 20%
- >20mmol/L - Increase insulin dose by 20%