Palliative medicine Flashcards
domperidone
pro kinetic
doesn’t cross blood brain barrier
odansetron
irritated gut for post chemo/radio
SE v constipating
levoprepromazine
multiple causes of N/V or unknown cause and inappropriate to ix
metaclopririmide
pro kinetic absolute bowel obstruction gastric stasis constipiated SE colic/cramps
cyclising
good for increased ICP
SE constipating
for constipaton stimulants
softners
senna, busidol
doxylase, lactulose
laxido
both stimulant and softner
what can help subacute constpation
steroids
what shouldn’t be given in obstruction and why
metacloprimide
domperidone
risk of perf
opiod toxicity
nightmares first
waking up still in a nightmare
drowsy
confused
visual hallucinations - peripheral shadows
delirum
in extreme: resp distress, myoclonic jerks
distress
midazolam 2mg SC hourly
immediate release onset 45 mins lasts 3-4 hours
pain/sob
morphine 2mg SC hourly
nausea, agitation
levomepromazine 2.5mg SC three hourly
resp secretions
hyoscine (buscopan) 20mg SC hourly
breakthrough for morphine
1/6 of total daily dose including fentanyl/buponephrine patches
if GFR 30-60
<30
renal impairment
oxycodone
alfentanil/fentayl
increases risk of toxicity
what GFR is the best
> 60
switch from oral morphine to infusion
half dose
codiene/tramadol for oral morphone
divide by 10
oral morphine to oral oxycodone
divide by 2
if high dose of morhphine and can’t get it through drive consider
diamorphine
katemine
fast acting anaesthetic palliative chronic pain dissociating
to treat opiod toxicity
alternate oxycodon - half the morphine dose
codeine divide by what to get morphoe dose
10
convert morphine to subcut if can’t swallow
half the total dose
buscupan
hyoscine budo
constipation causing nausea and vomitng
pro kinetic like metoclopririme
should hyoscine be prescribed in everyone
no not everyone has secretions
majority of deaths
dont occur in hospices
most at home
parental fluid in dying px
can be given
can you complete the DNA CPR without discussion it with the family
ye
amitrip and BP
causes hypotension
nausea related to opioids
wears off in 2 w
morphine treats agitation and distress
no midaz does
