palliative care key points Flashcards
Palliative mx of breathlessness
- rx of reversible cause
- oxygen
- morphine sulfate low dose
- lorazepam sublingual
- anti-depressants
- non-pharm
- positioning
- fan
- CBT
softening laxatives
docusate sodium
stimulant laxatives and when to avoid them
senna
bisacodyl
docusate sodium
cramping, avoid in obstruction
bulking laxatives and when not to use them
bran
fybogel
not in pall care - cant use with poor oral intacke or bowel motility
mech of bulking laxatives
increase fecal mass -> stimulating peristalsis
osmotic laxatives
lactulose
movicol / laxido
which laxatives do you use in pall care
- stimulent / osmotic
- the other
- suppository
- small enema
- phosphate enema
when to use cyclizine
- central vomiting
- CNS lesions
- labyrinthitis
when not to use cyclizine
- irritant SC
- severe heart failure
when to use ondansetron
- post chemo
- abdo surgery
- abdo radiotherapy
when not to use ondansetron
very constipating
QT prolongation
when to use haloperidol
- chemical causes
- renal failure
- drug induced
when not to use haloperidol
- lowers seizure threshold
- parkinsons
when to use metoclopramide / domperidone
- delayed GI transit
- bowel obstruction w/o colic
when not to use metoclopramide / domperidone
- bowel obstruction with colic
- parkinsons
- cardiac conduction dosorders
- young women
when to use levomepromazine
3rd line
when not to use levomepromazine
long half life
sedating
- lowers seizure threshold
- severe heart failure
- CVS disease
- parkinsons
common causes of nausea in pall care
WHO pain ladder
converting from oral morphine to SC morphine
divide by 2
converting from second line opioid to oral morphine
divide by 10
converting from oral morphine mg to fentanyl patch micrograms
divide by 3
how often are sustained release morphine given
BD
what is the % of oral morphine for PRN
1/6
converting from oral morphine sulfate to oral oxycodone
divide by 2
which opioids are safe in renal failure
fentanyl
alfentanil
buprenorphine
what are the anticipatory end of life medications
