Palliative Care/EOL Flashcards

1
Q

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

A

2.5-5mg Morphine SC PRN

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2
Q

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

A

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

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3
Q

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

A

Pain
Full bladder/rectum
Dyspnoea
Fear

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4
Q

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

A

Midazolam 2.5-5mg SC Stat and PRN

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5
Q

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

A

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

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6
Q

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

A

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

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7
Q

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

A

Improve patient position - 30 degree incline

Stop artificial hydration

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8
Q

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

A

Glycopyronium 200mcg SC stat then every 4h PRN

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9
Q

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

A

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

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10
Q

What should EOL patients be prescribed for Nausea and Vomiting?

A

Levomepromazine 2.5-5mg SC PRN

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

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11
Q

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

A

If already taking an opioid, titrate the dose up

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

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12
Q

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

A

Stop Metformin and Monitoring

Stop all analogues unless they need high dose insulin

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13
Q

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

A

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

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