Terminal care Flashcards
(26 cards)
What symptoms may indicate that prognosis is short?
- profound weakness
- confined to bed for most of the day
- drowsy for extended periods
- disorientated
- severely limited attention span
- losing interest in food and drink
- too weak to swallow medication
What kind of drugs should be prescribed?
- antisecretory: (hyoscine butylbromide aka buscopan)
- sedation (anxiolytic): midazolam/ levomepromazine
- analgesic: morphine sulphate
- antiemetic: cyclizine, haloperidol, metoclopromide
what are the indications for a syringe driver?
inability to swallow drugs due to reduced conscious level
- last days of life
- persistent nausea and vomiting
- intestinal obstruction
- malabsorption of drugs
- dysphagia
What medications can be given sub cut via a syringe driver? and what dose (over 24 hours)?
- diamorphine/ morphine sulphate (5mg up)
- cyclizine (100-150 mg)
- haloperidol (3-10 mg)
- metoclopramide (30-60 mg)
- levomepromazine(6.25- 100 mg)
- hyoscine butylbromide (60- 120 mg)
- hyoscine hydrobromide (400mcg- 2.4mg)
- midazolam (10-60mg)
what common drugs are unsuitable for a syringe driver?
- diazepam
- chlorpromazine
- prochlorperazine
when is levomperomazine indicated?
- antiemetic
- antipsychotic
- sedative
- useful second line sedative at higher does
how long acting are fentanyl patches?
- duration of 72 hours
how can vomiting causes be split up?
- cerebral
- toxic
- vestibular
- gastric
what would the symptoms be for gastric stasis?
- early satiety
- epgastric fullness
- hiccups
- heartburn
- minimal nausea between vomits
what may be the causes? (of gs)
- tumour
- hepatomegaly
- ascites
- dysmotility
treatment of gs nausea? Dose in a syringe driver?
- metoclopramide (10-20 mg) po/sc
- 30-60 mg SC over 24 hr
how would toxic nausea present?
what are the causes?
- persistent, small vomits and retching Caused by: - hypercalcaemia - uraemia - infections - drugs
how would you treat it?
what is the dose?
- haloperidol 1.5-5 mg po/ sc nocte
what symptoms may indicate a cerebral cause of n and v?
treatment?
- early morning headache
- vomiting
- little nausea
- cyclizine 50mg TDS po/sc
- cyclizine 150mg SC/ 24 hours
- Dexamethasone 8-16 mg
What might you give in anxiety/ anticipatory n and v?
- benzodiazepines (medazolam)
- CBT
- complementary therapy
for intermediate n and v?
- consider levomepromazine (6.25-12.5 mg_ nocte po/sc
name the three types of laxatives.
- bulking agents
- stool softener
- stimulants
name a bulk forming laxativie
name two stool softeners
- fybogel
- lactulose
- sodium docusate
note that movicol is also softener but also stimulant
name two stimulants.
when would you avoid stimulants?
- senna
- dantron
- avoid if patient has colic
What are the medications of choice opioid induced constipation?
- most patients require a softener and a stimulant :
- co- danthrusate, co-danthramer or movicol
what are the side effects of lactulose?
- significant bloating and flatulence
if bowels havent moved what would you do?
- consider rectal exam, suppositories and enemas after 3 days
In intestinal obstruction, what medications should the patient be taken off?
what should be prescribed instead?
- stimulant laxatives
- prokinetic drugs (metoclopramide)
- antispasmodics should be prescribed (hyoscine butylbromide)
what is the pharmacological treatment of breathlessness in terminal illness?
- opioids, decrease respiratory effort
- low dose, that does not cause respiratory depression
- benzodiazepines:
may help anxiety associated with breathlessness
(lorzepam/ midazolam for those who can not tolerate sublingual)
