Palliative prescribing Flashcards
Name 2 opioids for moderate pain
Codeine phosphate
Tramadol hydrochloride
Name 5 opioids for severe pain
Morphine Buprenorphine Oxycodone Methadone Fentanyl
Adjuvant treatment of pain due to bone mets
Radiotherapy
Bisphosphonates
Strontium Ranelate
Name the first line medications for neuropathic pain
Amitriptyline, nortriptyline (TCAs)
Carbamazepine for trigeminal neuralgia
2nd line for neuropathic pain
Anti-epileptics (pregabalin, gabapentin, carbamazepine)
If neuropathic pain not relieved by TCAs or antiepileptics, what can be used?
Tramadol
Use while waiting for a specialist review
What can be used for post-herpetic neuralgia?
Capsaicin cream or patch
What can be used to treat neuropathic pain caused by compression?
Prednisolone, reduced swelling and compression
Radiotherapy if spinal cord compression
What should be given for breakthrough pain when a pt is taking modified release oral morphine?
Immediate release oral morphine
If the dose of morphine is not covering the pain, what can be done?
Calculate how many rescue doses were taken in a 24hr period and increase the 24hr total dose by that much
Or, increase the dose by 1/3
What should be prescribed with morphine
Laxative (senna, lactulose, methylnaltrexone bromide)
Anti-emetic for first 3 days (haloperidol/metoclopramide)
Which analgesia can be given transdermally?
Fentanyl
Buprenorphine
What can help with anorexia and dysphagia?
Prednisolone
Dexamethasone
What can be given for excessive respiratory secretions?
Hyoscine butylbromide (buscopan) Glycoperonium bromide
3 options for capillary bleeding associated with liver failure
Tranexamic acid
Topical adrenaline
Vit K
What can be used prophylactically to prevent convulsion in pts with cerebral tumours or uraemia?
Phenytoin
Carbamazepine
or rectal diazepam
Treatment of dry mouth
Good mouth care
Sugar free gum
Sucking ice or pineapple chunks
Artificial saliva
Management of oral candida
Oral nystatin, fluconazole
Management of fungating tumours
Metronidazole
Regular dressings
Management of hiccup
Anti flatulant medicines (simeticone? asoefoetida?)
+ antacid (aluminium hydroxide)
2nd line: metoclopamide
2rd line: baclofen, nifedipine
Management of intractable cough
Moist inhalations
Morphine
(avoid methadone linctus)
Management of muscle spasm
Diazepam
Baclofen (muscle relaxant)
When is cyclizine used?
Raised IVP
Motion sickness
Mechanical bowel obstruction
Itching with obstructive jaundice
Emollients
2nd line: colestyramine
Management of restlessness and insomnia
Levomapromazine
Haloperidol
Midazolam
Name 6 signs of opioid toxicity
Myoclonic jerks Agitation Hallucinations Confusion Pin point pupils Respiratory depression
Which anti-emetics work well for gut problems?
Dopamine antagonists, work outside BBB
Domperidone
Also prokinetic
Which antiemetic works well for chemical causes of nausea?
Haloperidol low dose
Works at CTZ
Which antiemetic is useful in bowel obstruction?
Cyclizine
Not prokinetic
How do you treat breathlessness in end-of-life pts?
Opioids
Benzodiazepines
Management of hypercalcaemia?
Check calcium, renal function, albumin
Rehydrate (minimum 2L)
Bisphosphonates
