Palliative care

Batting order of anti-emetics:

  1. Metoclopramide
  2. Haloperidol
  3. Levomepromazine

Oxycodone may cause fewer central SEs than morphine. Different patients can have different levels of response to morphine & oxycodone.

For breakthrough pain, use buccal, sublingual, or intranasal medication – oral takes too long to work, and increasing the background dose in the absence of rest pain is going to lead to too many side-effects.

Note that there’s a high incidence of VTE in palliative care patients, associated with pain and suffering – prophylaxis with LMWH is frequently recommended, though I’m rather boggled by thoughts of the cost-effectiveness.

Although dexamethasone can be very useful, be aware of the side-effects of ongoing use – proximal myopathy can interfere with mobility, fractures can be a problem, steroid-induced psychosis is rare but horrible.

For malignant spinal cord compression, as well as arranging urgent admission and radiotherapy, start immediate dexamethasone 16 mg od.

(Pulse on-line learning module)

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About Dr Sarah

I'm a GP with a husband and two young children.
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