Palliative care Flashcards
(28 cards)
what ONE drug (first line) should you give someone who is bedbound
paracetamol
nothing else will be effective and will probs be in pain (cant communicate it)
second line pain management drug for someone in palliative care (eg bed bound)
weak opioid (eg codeine, co-codamol)
HO pain ladder
first line pain management drug for someone in palliative care
non opioid (eg paracetamol, NSAID)
WHO pain ladder
third line pain management drug for someone in palliative care
strong opioid (eg morphine)
WHO pain ladder
what is co-codamol
codeine and paracetamol
side effects of morphine (3)
resp depression, hallucinations, drowsiness
what happens if you stop morphine suddenly
withdrawal
when increasing the WHO pain ladder from step 2 (codeine) to step 3 (morphine) what must you remember
100mg of codeine = 10mg morphine!!
so start at same dose of pain relief (from above equation) then titre up
what are the 2 types of morphine
MST (PO)
oramorph (PO)
what does MST morphine do
background pain
moderate release drug = lasts all day
how often is MST morphine taken
BDS
what does oramorph (PO morphine) do
relieves ‘breakthrough’ pain
how often is oramorph (PO morphine) taken
PRN
if after a few days someone is taking MST morphine BDS AND lots of oramorph, what do you do
calculate the total morphine being taken and give all of this MST - so that only small amounts of oramorph are used
what happens to MST Po morphine when patient can no longer swallow
given through a syringe driver (SC)
what must you factor in when switching MST morphine from PO to SC through syringe driver
divide dose by 2
twice as potent SC
what 2 signs are common in dying patient
loss of interest/ability to eat food/fluids
sleeping more
who are prescribed a ‘just in case box’
what is in it
palliative patients
syringe driver - morphine, midazolam, levomepromazine, buscopan
give medications depending on symptoms
why is morphine in a just incase box
pain relief
why is midazolam (benzodiazepine) in a just incase box
for distress
why is levomepromazine in a just incase box
for nausea (is an antiemetic)
why is buscopan in a just incase box
for secretions
just incase box morphine dose and frequency
2mg SC hourly
just incase box midazolam dose and frequency
2mg SC hourly
