Palliative medicine Flashcards
In the terminal phase of the illness then agitation or restlessness is best treated with ………..
midazolam
In Palliative care, treatment of confusion or agitation
Underlying causes of confusion need to be looked for and treated as appropriate
specific treatments fail then the following may be tried:
first choice: haloperidol
other options: chlorpromazine, levomepromazine
Management of hiccups
chlorpromazine is licensed for the treatment of intractable hiccups
haloperidol, gabapentin are also used
dexamethasone is also used, particularly if there are hepatic lesions
What is the first-line to manage secretions in a palliative care setting
Hyoscine hydrobromide or
hyoscine butylbromide
Treatment of nausea and vomiting
cyclizine,
levomepromazine,
haloperidol,
metoclopramide
- CLMH
Treatment of pain
diamorphine is the preferred opioid
cyclizine is incompatible with a number of drugs including
Cats Drink Hot Milk, Keeping Mice Out Safely.”
Cats: Clonidine
Drink: Dexamethasone
Hot: Hyoscine butylbromide
Milk: Metoclopramide
Keeping: Ketamine, ketorolac
Mice: Midazolam
Out: Octreotide
Safely: Sodium chloride 0.9
cyclizine may precipitate with diamorphine when given at ……
higher doses
Opioid side-effects
Usually transient
Nausea
Drowsiness
Opioid side-effects
Usually persistent
Constipation
When increasing the dose of opioids the next dose should be ………
increased by30-50%.
the breakthrough dose of morphine is……
one-sixth the daily dose of morphine
all patients who receive opioids should be prescribed
laxative
in palliative patients with mild-moderate renal impairment
Which opioids is preferred ?
oxycodone is preferred to morphine
in palliative patients with renal impairment is more severe
Which opioids is preferred ?
alfentanil
buprenorphine
fentanyl
metastatic bone pain may respond to
strong opioids, bisphosphonates or radiotherapy.
Conversion between opioids
From oral codeine or tramadol to oral morphine divide by
10
Conversion between opioids
From Oral morphine to Oral oxycodone divide by
1.5 - 2
Conversion between opioids
From Oral morphine to s.c morphine
Divide by 2
Conversion between opioids
From Oral morphine to Subcutaneous diamorphine
Divide by 3
Conversion between opioids
From Oral oxycodone to Subcutaneous diamorphine
Divide by
1.5
transdermal fentanyl 12 microgram patch equates to approximately ….. mg oral morphine daily
30 mg
transdermal buprenorphine 10 microgram patch equates to approximately ….. mg oral morphine daily.
24 mg
Headache caused by raised intracranial pressure due to brain cancer (or metastases) can be palliated with
dexamethasone
Benzydamine hydrochloride mouthwash or spray may be useful in reducing the discomfort associated with
painful mouth that may occur at the end of life
