Palliative/ Geris Flashcards
Palliative medication: Agitation + confusion
Subcutaneous
1st - Haloperidol
2nd - chlorpromazine, levopromazine, midazolam
10mg PO Morphine equivalent PO opiates
codiene/ tramadol
oxycodone
Codeine/ Tramadol = 100mg (0.1 times)
Oxycodone = 6.6 (1.5 times)
Palliative nausea + vomiting Mx
Gastric motility - eg opiate related
- Metoclopramide, domperidone, haloperidol
Visceral (eg constipation)/ raised Intracranial pressure/ Vestibular
- Cyclizine
Cortical - eg pain, anxiety
- lorazepam, cyclizine
Conversion of PO Morphine to SC morphine
Divide by 2
Eg
PO Morphine 90mg = SC Morphine 45mg
Waterlow grading of pressure ulcers
Grade 1 - Non blanching erythema of intact skin
Grade 2 - Partial thickness skin loss involving dermis/ epidermis. (superficial abrasion/ blister)
Grade 3 - Full thickness skin loss to subcutaneous tissue not underlying fascia
Grade 4 - Extensive destruction, tissue necrosis - damage to muscle/ bone/ surrounding structures
Metastatic bone pain Mx
Analgesia
Bisphosphonates (eg zolendronic acid)
Radiotherapy
Breakthrough pain morphine calculation
x/6 = breakthrough dose
x = total dose over 24 hours
Donepezil SE
contraindication in bradycardia
SE = insomnia
Hiccups in palliative care Mx
Chlorpromazine
Haloperidol
Lewy body dementia Fx
visual hallucinations
dementia
Parkinsonism - eg resting tremors
Cognitive symptoms predate physical symptoms - this is the opposite for Parkinsons
Conversion of PO mOrphine to SC Diamorphine
Divide by 3
Eg. PO Morphine 90mg = SC Diamorphine 30mg
Lewy body dementia Mx
1st - Donepezil/ rivastigmine (Ach inhib)
2nd - Memantine
Do not prescribe neuroleptics as can develop parkinsonism
What medication is contraindicated in Parkinsons disease
Antipsychotics eg haloperidol
Delerium Mx
Address underlying cause, increase nursing care and modify environment
1st - Haloperidol 0.5mg PO
Palliative Mx - Respiratory secretions and Bowel colic
Hyoscine butylbromide
glycopyrronium bromide
PO Morphine to SC Diamorphine
Divide by 3
eg 120mg PO Morphine = 40mg SC Diamorph
Hiccups in Palliative care Mx
chlorpromazine
haloperidol
Alzheimer’s Mx
1st - donepezil, galantamine and rivastigmine (cholinesterase inhibitors)
2nd - Memantine
Donepezil - contra indicated in bradycardia. Can lead to insomnia
Seizures in Palliative care Mx
Midazolam SC continuously
What palliative medication must be mixed with water rather than saline
Cyclizine
All others mix with saline
