Lightning Learning: Anticipatory Meds for End of Life Care

Lightning Learning: Anticipatory Meds for End of Life Care

STOP!

People in the last days and hours of life may experience a spectrum of distressing physical symptoms, such as: pain, nausea, agitation, delirium, anxiety and/or respiratory tract secretions.

Consider…

  • Involving patients and relatives in discussions early

  • Reversible causes of symptoms and non-pharmacological approaches (e.g. repositioning for respiratory secretions)

  • Stop any medications that have no benefit and switch essential medications to non-oral routes (e.g. a subcutaneous infusion if the patient is unable to swallow)

LOOK

For pain and/or breathlessness: Morphine 2.5-5mg 1hrly SC PRN

For anxiety, agitation & seizures: Midazolam 2.5-5mg 1hrly SC PRN

For nausea, vomiting, hallucinations (don’t use in PD): Levomepromazine 2.5-5mg 4hrly SC PRN

For respiratory secretions: Glycopyrronium 200-400mcg 4hrly (Max 1.2mg/24hrs)

REMEMBER:

  1. Use lowest effective dose

  2. Reduce opiate dose =/- frequency in ESRF, very frail or low weight

  3. Consider ↑ PRN doses in patients taking regular opiates

LEARN

Complete local drug authorisation and controlled drug prescription for discharge.

Specialist Palliative Care Team: Ext. 5414/07950 888434 or via ICE referral (0900-1700 every day)

LOROS: OOH advice line 0116 231 8415

#SimBlog: A Tiny Surprise

#SimBlog: A Tiny Surprise

Lightning Learning: GREAT Palliative Discharge

Lightning Learning: GREAT Palliative Discharge