PALLIATIVE MEDICINE Flashcards
PAIN LADDER
Most initial : Nsaids : pmole , ibuprofen
Moderate : Codeine, dihydrocodeine
Tramadol
Strong Opioids: Morphine, fentanyl , oxycodone, diamorphine
NB: if s/e from morphine + switch to oxycodone
RENAL SAFE PAIN KILLERS
ALFENTANYL for flucuatiing pain
FENTANYL for steady pain
BUPRENORPHINE for steady pain AND
OXYCODONE
NON RENAL SAFE DRUGS
Morphine and diamorphine
Indications for s/c morphine
Indications for transdermal patches
S/C Morphine
1) diff in oral intake
2)unstable pain
3)end of life care
Transdermal patches
1) Diff in oral intake
2) chronic pain
Excessive respiratory secretions in palliative care
Glycopyrronium bromide s/c
or
Hyoscine Butylbromide s/c
Liver metastasis pain
No risk of bleeding : NSAIDs
Risk of bleeding ( thrombotic events or on anticoagulants) : Dexametasone
Hypercalemia
IV FLUIDS
IV MIDAZOLAM For anxiety
S/C MORPHINE FOR PAIN CONTROL
IV BISPHOSPHONATES - DEFINITIVE T/T
Severe hemetemesis
IV MIDAZOLAM OR IV MORPHINE
ANTIPICATORY MEDICINES IN PALLIATIVE
S/C Morphine for Pain and Breathlessness
S/C Haloperidol for Nausea and vomiting
S/C Midazolam for anxiety, delirium, agitation
S/C Hyoscine butylbromide : Noisy respiratory secretions
BREATHLESSNESS
- And Only wheeze : NEB SALBUTAMOL
- And No wheeze : Morphine
- And Respiratory Secretions: Hyoscine
- And Anxiety - Midazolam
Pain from Bone metastasis
Radiotherapy first line , followed by morphine for pain associated with radiotherapy
if not resolved then iv bisphosphonates
HICCUPS
Diaphragmatic causes : Metoclopramide
Central causes
Chlorpromazine
NB: if both are not an option , any one can be considered for hiccups
HALITOSIS
Oral cause : Antiseptic mouth wash + oral hygiene
Non oral cause : Antibiotics
NEUROPATHIC PAIN IN PALLIATIVE CARE
Amitriptyline - first line for cancer related neuropathic pain
Duloxetine - for diabetic neuropathic pain
Antiemetics in palliative care
Radiotherapy associated vomiting :
Ondansetron, haloperidol
Chemotherapy associated vomitng : Ondansetron,Metoclopramide
Conditions causing raised ICP:
Cyclizine or dexametasone
Mechanical bowel obstruction : Cyclizine first line , followed by hyoscine butylbromide or octreotide
Delayed gastric emptying : Metoclopramide or domperidone
Avoid haloperidol and metoclopramide in parkinsonism
Safe in parkinsons
domperidone, ondansetron , cyclizine
LAXATIVES
BULK FORMING - ISPAGHELLA HUSK
OSMOTIC LAXATIVES : LACTULOSE, MACROGOLS
STIMULANT LAXATIVES :
SENNA , BISACODYL
FAECAL SOFTENERS
Glycerol suppositories , docusate sodium
CONSTIPATION MANAGEMENT
First line : Dietary measures followed by isphagula husk
Second line ( when constipation persists ) : Lactulose or Senna
CONSTIPATION IN CHILDREN
Macrogol macrogol
FAECAL IMPACTION
HARD STOOL
1) MACROGOL
if not resolved
2) SENNA
if not resolved
3) GLYCEROL SUPPOSITORIES
if not resolved
4) DUCOSATE SUPPOSITORIES
if not resolved
5) Phosphate enema
FAECAL IMPACTION - SOFT STOOL
SOFT STOOL
1) SENNA
if not resolved
2) Biscadoyl suppositories
if not resolved
3) DOCUSATE SUPP
if not resolved
4) PHOSPHATE ENEMA
