Palliative medicine Flashcards
What are Advanced Care Plans ACPs
Made with patients wishes in mind for end of life care
Step 1 in pain management
Paracetamol 1g x4daily
+- NSAID e.g. naproxen 500mg x2daily
+- other adjuvant
Step 2 in pain management
Codeine phosphate 30-60mg x4daily
or
Co-codamol 30/500 mg 2 tablets x4daily
Step 3 in pain management
STOP codeine
Start strong opioid, usually morphine sulfate
Give example of adjuvants and their uses
MSK pain –> NSAID
Neuropathic pain –> gabapentin, tricyclic antidepressant
Can be added at any point in WHO analgesic ladder
What are the different types of pain and what kind of morphine is used
Background pain - modified release morphine
Breakthrough pain - immediate release morphine
Give examples of modified release morphine (MR)
MST, zomorph
Give examples of immediate release morphine (IR)
sevredol tablets
oramorph liquid
How do you calculate the dose of immediate release morphine for breakthrough pain
1/6th of total modified release morphine
e.g. 30mg MR –> 5mg IR morphine
10mg PO morphine = ? SC morphine
5mg SC morphine
10mg PO morphine = ? PO oxycodone
5mg PO oxycodone
What are some signs of morphine toxicity
Hallucinations Vivid dreams Confusion Myoclonus (jerky flicking movements) Sleepiness Pin point pupils Respiratory depression
Management of opioid toxicity is to completely reverse all opiates in body, true or false
FALSE, these patients are still suffering from pain and so still need opioids for pain control
Management of opioid toxicity
Check renal function (U+E, GFR)
switch to a non-renally excreted opioid
fluids to dilute opioid in system
Naloxone is for serious toxicity ie respiratory depression
List reversible factors that may mimic death
Drug toxicity AKI Hypercalcaemia Hypoglycaemia Sepsis
Which medicines can be prescribed for the following symptoms at end of life: Pain/SOB Distress Nausea Respiratory secretion
Morphine
Midazolam
levomepromazine
hyoscine/buscopan
What is done when confirming death
check for: spontaneous movements and respiratory effort response to voice + pain palpate 2 major pulses for 1 min eyes: dryness, clouding cornea, fixed dilated pupils, no corneal reflex auscultate heart and lungs for 1 min NOTE any metallic device eg pacemaker Record time and date of death
PO morphine to SC diamorphine conversion
divide by 3
PO morphine to SC morphine conversion
divide by 2
PO morphine to PO oxycodone
divide by 2
PO oxycodone to SC oxycodone
divide by 2
