Syringe drivers Flashcards
(24 cards)
What is a syringe driver? What is it used for?
it is a small battery-operated pump that is portable
it is used for symptom management
- it delivers continuous subcutaneous or intravenous administration of medications
What are the indications for a syringe driver?
persistent nausea and vomiting
inability to swallow oral medicine
poor GI absorption
profound weakness and/or unconsciousness
What drugs are most commonly used in syringe drivers?
usually 2-3 drugs
diamorphine with
- midazolam
- metoclopramide
- levomepromazine
- haldol and midazolam
What should be considered when using syringe drivers?
compatibility of drugs
- usually 2-3 drugs
- pH of drugs
= acid and alkali used together will form a salt (precipitate) and water
= dexamethasone and midazolam
stability
- temperature, light, concentration and diluent (WFI, NS, D5W)
How can stability issues be minimised?
dilute to maximum volume
protect from light
consider temperature
deliver over 24 hours
What is the issue with licensing for syringe drivers?
Combining 2 or more licensed drugs in a syringe driver results in a new product that requires a license
What are the concerns related to syringe drivers?
Errors
- Introduction of new pumps
Expertise
- Education and training
Misconceptions
- ‘Does not hasten death’
What are the advantages of using syringe drivers?
precise medicine delivery - accurate and controlled dosing
continuous infusion avoids fluctuations in dosage
customisable for patient need
increases patient mobility - can be portable
What are the disadvantages of syringe drivers?
increases costs - to buy, maintain, repair
require training to set it up and use
risk of technical faults
relies on battery power so limited use
some drugs are incompatible - blockage
Why is subcutaneous administration preferred over intravenous in palliative care?
easier administration - no need to locate a vein
less risk of infection
less painful
flexibility in site selection
sterile
What is end of life?
What is terminal care?
What is bereavement care?
people who are likely to die within the next 12 months
care of those in their last few weeks or days of life.
care and support of the patient and their families throughout their illness, and after the patient’s death.
What is palliative care?
covering or masking the symptoms and the effects of incurable disease for alleviating or reducing suffering
What is cachexia?
weakness and wasting of the body due to severe chronic illness.
- characterised by weight loss via skeletal muscle and adipose tissue loss, fatigue, anorexia, abnormal biochemistry, an imbalance in metabolic regulation, and reduced food intake.
What is sarcopenia?
loss of muscle mass
What is deprescribing?
safe withdrawal of medicines that are no longer appropriate, beneficial, or wanted (patient preference), to improve quality of life and reduce the burden of unnecessary treatments, particularly in the final months of life.W
What are the benefits of continuous subcutaneous infusions (CSCIs)?
reduce the need for bolus injections, provide comfort from stable drug plasma concentrations, and allow control of multiple symptoms with a combination of drugs.
What are the types of adjuvant analgesics?
antidepressants/neuropathic pain
- amitriptyline = TCA
- duloxetine, venlafaxine, = serotonin-noradrenaline reuptake inhibitor
- gabapentin = gabapentinoid
antipsychotics
What are different benzodiazepines, their mechanism of action and indication?
midazolam, diazepam
facilitating the binding of the inhibitory neurotransmitter GABA at GABA receptors
- increase activity of GABA
anorexia, anxiety, sedation
What antipsychotic is used for managing agitation where delirium is prominent?
haloperidol
- 1st gen typical antipsychotic
What is the mechanism of action of propofol?
positive modulation of the inhibitory function of the neurotransmitter gama-aminobutyric acid (GABA) through GABA-A receptors
What drugs are added to difficult to sedate patients?
Clonidine
- acts by stimulating the pre-synaptic alpha 2 adrenoceptors
What scoring system should be used to assess pain
Behavioural pain score
Self reported pain score
What scoring system should be used to assess sedation and agitation?
Richmond Agitation-Sedation Scale
What non-pharmacological measures can be used to prevent embolism?
graduated compression stockings
intermittent pneumatic compression devices
inferior vena cava filters.
