Palliative Care

Question 1

What are the five simple guidelines for managing pain in palliative care?

Answer 1

By mouth (give orally where possible)
By clock (give at fixed intervals for continuous relief)
By ladder (WHO pain ladder)
For individual (no standard opiate dosages)
W/ attention to detail (pt education)

Question 2

How can strong opioids be used in palliative care?

Answer 2

5-10mg/4h oramorph w/ equal prn
   -2x doses at night
   -inc by 50% if pain controlled but doesn't last 4hrs
Once 24hr req established change to MR
SC diamorphine if oral not tolerated

Question 3

What adjuvants to opioids may be used in palliative care?

Answer 3

SSRIs if associated w/ depression
Muscle relaxants (tension-type pain/spasticity)
Amitryptyline/Gabapentin for breakthrough pain

Question 4

What management is available for palliative management of N&V?

Answer 4

Cyclizine

Metoclopramide

Question 5

What management is available for palliative management of constipation?

Answer 5

As per opioid induced

-senna & lactulose

Question 6

What management is available for palliative management of breathlesness?

Answer 6

Morphine

Supplementary O2

Question 7

What management is available for palliative management of pruritis?

Answer 7

Chloraphenamine

Cholestyramine

Question 8

What management is available for palliative management of secretions?

Answer 8

Hyoscine hydrobromide

Question 9

What management is available for palliative management of agitation?

Answer 9

Midazolam