Palliative Care Prescribing Flashcards
What is used to manage hiccups in palliative care?
Chlorpromazine.
Haloperidol and Gabapentin also used.
Dexamethasone used if there are hepatic lesions.
What is used to manage agitation and confusion in palliative care?
Initially - Treat underlying cause (i.e hypercalcaemia, infection, UTI, medication)
1st - Haloperidol
2nd - Midazolam (If in terminal phase of illness)
What is used to manage secretions in palliative care?
Conservative;
Avoid fluid overload (stop IV or SC fluids)
Medical;
Hyoscine hydrobromide or Hyoscine Butylbromide
(Butylbromide is less sedative than hydrobromide)
Name 3 causes of nausea and vomiting in palliative care
Gastric Stasis
Bowel obstruction
Biochemical abnormalities (hypercalcaemia, opioids or chemotherapy)
Drugs
What medications are used to treat nausea and vomiting associated with gastitis, gastric stasis or functional bowel obstruction, in palliative care? And why?
Metoclopromide or Domperidone
As have prokinetic actions
What is used to treat nausea and vomiting due to Biochemical causes (hypercalcaemia, morphine, renal failure), in palliative care?
Haloperidol
What is used to treat nausea and vomiting due to raised ICP and/or vestibular dysfunction, in palliative care?
Cyclizine + Dexamethasone
What is the preferred 1st line medication for managing seizures in palliative care?
Levetiracetam
What is the starting treatment for managing pain in palliative care?
Regular Oral Modified Release (MR) Morphine or Oral immediate release morphine (pt preference) with oral immediate release morphine for breakthrough pain.
What dose of MR is given to patients with no co-morbidities?
20-30mg a day with 5mg for breakthrough pain.
(i.e 15mg MR twice a day with 5mg oral morphine solution)
What should be co-prescribed to patients initiating strong opioids?
Laxatives
A breakthrough dose is usually what fraction of the daily dose of morphine?
1/6th
What opioid is preferred in patients with CKD?
Oxycodone is preferred over morphine in patients with mild-moderate disease.
Alfentanil, Buprenorphine and Fentanyl are preferred in severe disease
When increasing a dose of opioids, the next dose should be increased by what?
30-50%
Give 1 persistent symptom of opioids
Constipation
