Prescribing for EOLC

Question 1

An EOL patient is confused and agitated. Which pharmacological and non-pharmacological measures would you use?

Answer 1

Non-pharma: a human presence often helps calm agitated patients.

Where anxiety/anguish are predominant: MIDAZOLAM 2.5-5 mg stat. and PRN SC. May need to be repeated after 30 mins.
(If 2+ doses in 24 hrs have been given with effect, consider starting SC infusion 5-10 mg/24 hrs. Dose may need to be gradually increased to 30 mg/24 hrs).

Where delirium/psychotic features are predominant: HALOPERIDOL 5 mg stat. and 2.5-5 mg PRN SC (max. TDD 10 mg).
Consider giving by SC infusion.

Question 2

An EOL patient demonstrates noisy respiratory secretions. How would you manage them?

Answer 2

1. Consider whether they are troublesome/do not need treatment.
2. Consider change in position of pt and stopping IV fluids, SC fluids or PEG feed.
3. If troublesome secretions: GLYCOPYRRONIUM 200 ug stat. and PRN (up to every 4 hrs).
   Consider SC infusion 800 ug/24 hrs if 2+ doses given and effective. If symptoms persist, increase to max. of 1.2 mg/24 hrs.

Question 3

An EOL patient is troubled by nausea and vomiting. He is not on any anti-emetic. How would you manage him?

Answer 3

HALOPERIDOL 1.5 mg SC stat. and PRN.

If 2+ doses given and effective, consider SC infusion 5 mg/24 hrs. Max. TDD 10 mg.

Question 4

An EOL patient is complaining of pain. They are not currently on any pain relief. How would you manage them?

Answer 4

1. DICLOFENAC 100 mg PR stat and 50 mg PR BD.
2. MORPHINE 2.5 mg-5 mg SC PRN.
3. Review need for continuous morphine infusion later in day.

Question 5

An EOL patient is complaining of pain. They are currently taking an NSAID. How would you manage them?

Answer 5

1. MORPHINE 2.5 mg-5 mg SC stat + PRN.
2. MORPHINE 10-20 mg/24 hrs.
3. HALOPERIDOL 3 mg/24 hrs as prophylactic antiemetic.

Question 6

An EOL patient is complaining of pain. They are currently on taking oral morphine. How would you manage them?

Answer 6

1. Convert to continuous MORPHINE SC infusion via syringe driver. TDD oral morphine/2 = mg morphine/24 hrs.
   Increase infusion as needed to control pain by 30% steps.
2. Prescribe PRN morphine SC for breakthrough pain = 1/6 TDD.