Lightning Learning: Anticipatory Meds for End of Life Care
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.
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)
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)
Use lowest effective dose
Reduce opiate dose =/- frequency in ESRF, very frail or low weight
Consider ↑ PRN doses in patients taking regular opiates
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