analgesics (to treat pain) antiemetics (to treat and also to prevent nausea and vomiting) laxatives / aperients (to prevent and treat constipation) adjuvant medications (medicines that work with analgesics to improve pain or symptom control)
The most commonly prescribed drugs include acetaminophen, haloperidol, lorazepam, morphine, and prochlorperazine, and atropine typically found in an emergency kit when a patient is admitted into a hospice facility.
Medicine for pain in palliative care – an appropriate opioid, for example, morphine, diamorphine, oxycodone or alfentanil. Medicine for breathlessness – midazolam or an opioid. Medicine for anxiety – midazolam. Medicine for delirium or agitation – haloperidol, levomepromazine, midazolam or phenobarbital.
simple painkillers for mild pain – like paracetamol, aspirin and ibuprofen. weak opioids for moderate pain – like codeine and tramadol. strong opioids for severe pain – like morphine, oxycodone, buprenorphine and fentanyl.
Terminally ill cancer patients near the end of life can experience refractory symptoms, which require palliative sedation. Midazolam is the most common benzodiazepine used for palliative sedation therapy.
Adverse effects were similar in the groups receiving regular, high, and very high doses of morphine. The median survival of patients treated with high doses of morphine was 27 days and was 37 days for those treated with very high doses.
Codeine is best used in conjunction with paracetamol or aspirin. Oxycodone or methadone are alternatives to morphine. Neither of these drugs is metabolised to morphine. Oxycodone can be given as a tablet and has a useful suppository formulation.
A bystander hands a medicine bottle to the attending paramedic frantically saying, “They drank this! They drank this!” The bottle contains digoxin 100 mg, diazepam 1,000 mg, morphine 15,000 mg, amitriptyline 8,000 mg and phenobarbital 5,000 mg.
Opioids are used for pain and breathlessness. Most patients with palliative care needs respond well to titrated oral morphine.
The recommended sequence of doses is: 2.5mg – 5 – 7.5 – 10 – 15 – 20 – 30 – 40 – 60 – 80 – 100 – 120mg 4 hrly. 4. BREAKTHROUGH DOSE • A breakthrough dose is given at any time if pain occurs, irrespective of the regular dose. It is always the same as the 4 hourly dose.
Palliative care is customarily provided at the end of life. Palliative medicine, however, is akin to medical sub-specialties like cardiology and is a plan of care to enhance the lives of people who have long-term (not terminal) diseases or who are seeking curative treatments for their disease.
Palliative sedation is a measure of last resort used at the end of life to relieve severe and refractory symptoms. It is performed by the administration of sedative medications in monitored settings and is aimed at inducing a state of decreased awareness or absent awareness (unconsciousness).
Terminal restlessness generally occurs in the last few days of life. Around 42 percent of hospice patients experience agitation during their final 48 hours. But even more develop symptoms before then, which may not subside until death.
In the simplest terms it means that the medication required to abate suffering cannot be given without the probable result of hastening death.
The end-of-life period—when body systems shut down and death is imminent—typically lasts from a matter of days to a couple of weeks. Some patients die gently and tranquilly, while others seem to fight the inevitable. Reassuring your loved one it is okay to die can help both of you through this process.
— Giving food and fluids by artificial means (e.g., intravenously) does not usually prolong life or improve its quality. — Providing food and fluids by artificial means may, in fact, increase distressing symptoms such as shortness of breath, respiratory congestion, restlessness, nausea and vomiting.
In the last days of a person's life, secretions (fluid) might build up in the airways as they become too weak to cough and clear them. This causes a gurgling or rattling sound when the person breathes in and out and is sometimes called 'the death rattle'.
For hospice patients who have trouble breathing, small amounts of well-controlled and regularly titrated morphine can help ease respiratory distress by decreasing fluid in the lungs and altering how the brain responds to pain.
Everyone's experiences are different, but there are changes that sometimes happen shortly before a person dies. These include loss of consciousness, changes to skin colour, and changes to breathing.
In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before.
As a result of discontinuing eating, patients can die in as early as a few days. For most people, this period without food usually lasts about 10 days, but in rare instances, it can last several weeks.
A syringe driver (or syringe pump) is a small battery-powered pump. It delivers a steady stream of medication through small plastic tube under your skin. You might have a syringe driver for medicines that help with pain, sickness, fits, agitation and breathing problems.
People are considered to be approaching the end of life when they are likely to die within the next 12 months, although this is not always possible to predict. This includes people whose death is imminent, as well as people who: have an advanced incurable illness, such as cancer, dementia or motor neurone disease.
You might be unable to stop crying and worrying. Or you might feel that there is no point in doing anything. You might also find it difficult to see life going on as normal for most people. It can feel very strange to watch people go about their daily lives, do shopping, drive, and work.