Prescribing in Palliative Care and Elderly Patients Flashcards
(50 cards)
What is the first line oral analgesic used in palliative care
morphine
What oral morphine forms are there
Immediate release
- 4 hourly (not more then 1/2 of the total daily dose per increment)
Modified Release
- 12 hourly
- 24 hourly
when pain is controlled, switch from quick to slow release within 4 hours of last dose
What is breakthrough pain
pain the occurs between regular doses of strong opioids
How to treat breakthrough pain
use a rescue dose
1/10 to 1/6 of total daily dose immediate release
repeat every 2 to 4 hours when required
When should you use parental forms of analgesics
- dysphagia
- severe nausea / vomiting
- coma
- weakness
Parental morphine dose compared to oral
Parental is half of oral dose
Parental diamorphine dose compared to oral
parental is third of oral dose of morphine
Why is parental diamorphine preferred over parental morphine
- more soluble
- large dose in small quantity
- ideal in emaciated patient (huge loss of muscle and fat)
What are the two solutions for injection
- Saline
- Water for injection
SC diamorphine concentration and injections solutions
- Diamorphine concentration goes up to 250mg/ml
- If the strength prescribed is 40mg/ml or above, the injection solution used must be water for injection to avoid precipitation
When should you use transdermal patches over parental analgesia
if a patients pain can be managed by in immediate release opioid
Why should you use transdermal patches over parental analgesia for patients with pain stabilised by immediate release opioid
This stability suggests that their pain management needs are predictable and can be maintained with a consistent delivery system like a patch.
What should happen to a patch’s dose if switching due to hyperplasia
reduce dose by 25 to 30%
What are opioid side effects
- constipation
- nausea / vomiting
- dry mouth
Managing opioid side effects: Constipation
laxative should be prescribed
- senna + lactulose
- co-danthramer
Managing opioid side effects: Nausea / vomiting
- Metoclopramide
- Haloperidol (4 to 5 days)
Managing opioid side effects: Dry mouth
- maintain good oral hygiene
- suck on ice cubes
- artificial saliva
- can be due to candidiasis (antifungal= nystatin, fluconazole)
Other types of pain and how to treat
- Neuropathic
(tricyclic antidepressants / anti-epileptic) - Bone Metastases
(bisphosphonates, strontium ranelate) - Pain due to nerve compression
(dexamethasone)
Symptoms in palliative Care
- Anorexia
- Bowel colic and excess respiratory secretions
- capillary bleeding
- convulsions
- dysphagia due to obstruction by tumour
- Dyspnoea
- Fungating tumours
Symptoms in Palliative Care Part 2
- Gastric distenion
- Hiccup due to gastric distension
- insomnia
- intractable coughs
- muscle spasms
- nausea and vomiting
- pruritis
- headache due to raised intracranial pressure
- Restlessness and confusion
How to treat Symptoms on palliative care: Anorexia
- Prednisolone
- Dexamethasone
increases appetite/weight gain
How to treat Symptoms on palliative care: Bowel colic and excess respiratory secretions
- subcutaneous injections of Hyoscine
Bowel colic (painful cramps)
- Loperamide
How to treat Symptoms on palliative care: Capillary Bleeding
- Tranexamic acid
- Adrenaline
- Vitamin K
How to treat Symptoms on palliative care: Convulsions
- Phenytoin
- Carbamazepine
- SC Midazolam
