Palliative Medicine

Question 1

Managemt of anxiety in palliative care

Answer 1

● Be calm, reassuring and present, allow for family to
be by bedside if possible.

ORALLY
L o ra z e p a m 1 m g – 2 m g S L q 2 h p rn u n til s e ttle d ,
th e n 6 -1 2 h (p re fe rre d )
O R D ia z e p a m 2 ,5 m g p o p rn u n til s e ttle d -
th e n 5 m g - l0 m g p o b d
S U B C U T bolus
Midazolam 2,5 mg – 5 mg SC hourly until symptoms
settled

Question 2

Management of derilium in palliative care

Answer 2

● Exclude reversible causes like hypoxia,
urinary retention, constipation, pain
● Use medication only if patient is distressed,
hallucinating or danger to self or others.

Haloperidol 0,75mg po hourly until settled; then
q4h prn OR Haloperidol 2.5 mg – 5 mg sc over 24
hours up titrate to 10 mg as needed.
Midazolam 2,5 mg – 5 mg SC hourly until
symptoms settled or 5 – 15 mg over 24 hours
continuous infusion up titrate as necessary

Question 3

End of life care management of pain in patients

Answer 3

For End of Life Care (EOLC)
Initial stat oral/sc doses will be required.
Morphine for PAIN: calculate oral morphine dose
required over 24h, divide total dose by 2-3 and
deliver this over 24h by continuous sc infusion.
Or if not previously on Morphine start:
Morphine 30 mg + Metoclopramide 30 mg
IF RENAL FAILURE
Morphine 10 mg + Metoclopramide 20mg or
Haloperidol 2,5 mg
Can also add haloperidol 5mg or Midazolam 10
mg if agitated.
Buscopan 40mg - 80mg/24h SC for respiratory
secretions
Can use a maximum of 3 drugs per SCI

Question 4

Management of dyspnoea in palliative medicine

Answer 4

● Treat underlying cause
● Correct positioning and breathing techniques-
‘smell the roses, blow out the candles’
● 02 if sats <90% (if resources allow)

O ra l m o rp h in e 2 m g – 5 m g (0 .5 m l – 1 m l) p o P R N u p
to 4 h rly a n d in c re a s e if n e e d e d .
O R M o rp h in e 1 m g - 2 m g S C /IV P R N o r 1 0 m g o v e r 2 4
h rs v ia c o n tin u o u s s c in fu s io n , c a n titra te u p a s n e e d e d .
N ote:
In c re a s e d o s e b y 2 5 % if p a tie n t is s tru g g lin g , u n til
c o m fo rta b le
U s e lo w e r d o s e s a n d b ig g e r d o s a g e in te rv a ls in e ld e rly
Always prescribe rescue doses of morphine: 24h dose +6
A d d m e to c lo p ra m id e 1 0 m g q 8 h p o /iv /s c fo r n a u s e a s /e

Question 5

How to manage secretions in palliative care

Answer 5

Buscopan
/hyoscine

Question 7

Management of side effects of morphine

Answer 7

Side-Effects of Morphine
• Nausea and Vomiting: metoclopramide 10mg tds po for at least a
week to cover for this.
• Constipation: ALWAYS prescribe a stool softener with a stimulant
laxative:
• Stool softener – lactulose 15ml nocte/ bd po or 30mg d po, Sorbitol
15ml bd po/30mg d po
• Stimulant laxative – Senna 2-4 tabs nocte po, Bisacodyl 2 tabs nocte
po
• Drowsiness: education