5: Ageing and end of life care

Question 1

http://www.palliativecareguidelines.scot.nhs.uk/

Question 2

WHO pain ladder

Question 3

opioid withdrawal & naloxone

Question 4

morphine dose for breakthrough pain is 1/6 of the background dose

Question 5

to convert codeine dose to morphine dose, divide by 10

because morphine is 10x stronger

Question 6

look at calculations

Question 7

key information summary contains patient’s wishes in the event of deterioration

Question 8

death mimics:

opioid overdose

sepsis

hypercalcaemia

acute kidney injury

hypo

Question 9

syringe driver

pump for continous subcutaneous infusion of drugs - pain management, secretions etc.

Question 10

subcutaneous morphine is twice as potent as other routes

so half dose for syringe drivers

Question 11

buscopan (hyoscine butylbromide) used to reduce respiratory secretions

morphine for pain

midalozam (class?) for distress

levomepromazine for nausea

Question 12

myoclonus, hallucinations, vivid dreams –> opioid toxicity