End of Life Care Flashcards
On the WHO ladder, what is Step 1 drugs for mild pain
Acetaminophen
NSAIDs
Aspirin
+/- adjuvants
on the WHO ladder, what is Step 2 drugs for moderate pain
Aspirin or Acetaminophen Codeine Hydrocodone Oxycodone Dihydrocodeine Tramadol \+/- adjuvants
on the WHO ladder, what is Step 3 drugs for severe pain
Morphine Hydromorphone Methadone Levorphanol Fentanyl Oxymorphone \+/- non opioid analgesics \+/- adjuvants
percentage of opioids of 24 hours that is given for breakthrough pain
5-15%
AE of opioids
nausea
sedation
constipation
respiratory depression
how do you treat opioid induced constipation
stool softeners like docusate not enough …stool stimulants are needed
how do you treat opioid induced nausea/vomiting
anti emetics like metoclopramide
treatment for burning tingling pain
TCAs like amitriptyline and imipramine
Gabapentin
treatment for shooting stabbing pain
Gabapentin
Carbamazepine
Valproate
treatment for transient or mild diarrhea
Bismuth salts
treatment for persistent/bothersome diarrhea (slow peristalsis)
Opioid agonists: Loperamide and Diphenoxylate
Atropine
Tincture of Opium
treatment for persistent, severe secretory diarrhea
Somatostatin analog: Octreotide
Parenteral fluid support
DOC for dyspnea in end of life care
Opioids: Morphine
how do you treat fatigue/weakness in end of life care
- discontinue medications that are no longer appropriate and making fatigue worse like antihypertensives, diuretics
- optimize fluid and electrolyte intake
- corticosteroids
- psychostimulants (methylphenidate)
