Palliative meds Flashcards
Hyoscine Hydrobromide/ butylbromide drug class and clinical indications
Class: Antimuscarinic
ClinInd: To reduce respiratory secretions
Hyoscine hydro and butylbromide moa?
Elimination?
Competitively blocks acetylcholine from muscarinic receptor
Stimulation of muscarinic receptor causes rest and digest
This reduces secretions from glands in the respiratory tract and gut
Elim: Metabolised by liver, excreted in urine
Hyoscine hydro and butylbromide SEs?
Drowsiness/ confusion in the elderly. Sedation EO- hydro
Blurred vision (occur secondary to blockage of cholinergic stimulation to the ciliary muscle of the crystalline lens)
Dry mouth
Tachycardia
Constipation
Urinary retention
Hyoscine hydro and butylbromide interactions
Adverse effects are more pronounced when combined with other antimuscarinic drugs e.g. TCAS
Hyoscine hydro and butylbromide dose and administration ?
Hyoscine hydro: SC 400mcg. 1.2-2.4 mcg in 24 hours
Hyoscine butylbromide: SC: 20mg. 60-120mg in 24 hours
Midazolam drug class and clinical indications (palliative)
Benzodiazepine
For relief of short term severe, disabling or distressing anxiety
Miadazolam moa?
Elimination
Targets GABA-A chloride channel which normally opens in response to GABA binding.
It is the main inhibitory NT in the brain
Benzodiazepine allows enhanced binding of GABA to GABA-A
This has a widespread depressant effect
Metabolised by liver
Contraindications/ warnings of midazolam?
Elderly should receive lower doses
Avoid in liver failure as it’ll precipitate hepatic encephalopathy
Avoid in pts with resp impairment or NMD
Midazolam interactions?
Effect of benzos are additive to those of other sedating drug inc alcohol and opioids
Benzos depend on cytoP450 metabolism. so P450 inhibitors e.g. amiodarone, diltiazem, macrolides and fluconazole may increase depressive midaz’ effect
Midazolam starting dose?
24 hour dose?
SC PRN: 2-5mg
24 hour: 10-80mg
Diamorphine drug class and clinical indications
Strong opioid
Analgesic purposes EOL
Diamorphine moa?
Elimination?
Agonist that acts on mu, kappa and delta receptors
Excreted via the kidneys as glucuronides
Diamorphine SEs?
Respiratory depression Nausea and Vomiting Decreased motility in GIT Suppression of cough reflex Hypothermia
Diamorphine contraindications?
Cautions?
Should be given in reduced doses or with caution to pts with asthma or decreased respiratory reserve
Contraindicated in patients with delayed gastric emptying and phaeochromocytoma patients
Caution in patients with severe cor pulmonale, severe diarrhoea and toxc psychosis
Diamorphine interactions?
Benzodiazepines + opioids= NO GO= potentially fatal respiratory depression
Diamorphine starting dose?
24 hour dose?
1.25 – 2.5 mg if opioid
naive otherwise
calculate appropriate
dose (subcut prn)
24 hours: 5-10 mg/24 hours if opioid naïve. Otherwise
calculate appropriate
dose
Levomepromazine drug class?
Clinical indications?
Phenothiazine
Used for unresolved N+V (3rd line) and for severe delirium/ agitation in the last days of life
Levomep MOA?
Levomep elimination?
Adrenergic, dopamine, histamine, cholinergic and serotonin receptor antagonist
Excreted in faeces and urine- half life 20 hours
Levomep SEs?
Skin irritation at infusion site Drowsiness Dry mouth Dystonia QT prolongation
Levomep contraindications?
Levomep, cautions?
Contraindicated in CNS depression, comatose states and phaeochromocytoma
Caution
Lowers BP and can cause hypotenion in ambulant patients: pts receiving large doses should remain supine
Has additive sedative effect
Liver impairment- doe reduction and careful titration
Levomep interactions?
Levomep is a potent inhibitor of cytochrome P450: will result in increased plasma concentration
Increased risk of arrythmias when combined with drugs that prolong QT interval e.g. procainamide, amiodarone. Has this effect with erythromycin IV and TCAs e.g. amytriptylline and antihistamines
Levomep route of administration and dose?
S/C starting dose: 6.25mg
24 hours dose: 6.25-25mg
