Resources

Resources developed for GPs as part of Decision Assist:

• Advance Care Planning in General Practice: Guidance on use of MBS Items (182kb pdf)
• Professor Liz Reymond - 'The Framework of care' for GPs (video 3:28mins)
• Dr Greg Parker - Pain assessment, management and initiating opioids (video 15:41mins)
• Dr Will Cairns - An introduction to the management of delirium in the palliative care environment (video 15:54mins)
• Professor David Currow - An introduction to the management of dyspnoea in the palliative care environment (video 11:25mins)
• Dr Lawrie Palmer - An introduction to the management of nausea and vomiting in the palliative care environment (video 13:09mins)

This medicine information is endorsed by The Australian and New Zealand Society of Palliative Medicine (ANZSPM), April 2017.

CLONazepam

​Usual route of administration

• Oral drops
• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Anxiety
• Prevention / treatment of seizures (PBS)
• Terminal agitation / restlessness
• Sedation

Comments

• Recommendation: low initial dosing and frequent reassessment
• Oral administration: count oral drops onto a spoon prior to putting into mouth. Three drops ≈ 0.3 mg
• Oral CLONazepam is well absorbed by buccal mucosa
• Subcutaneous administration: CLONazepam adsorbs to PVC so should preferably be given using PVC-free equipment

Fentanyl

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Pain
• Shortness of breath

Comments

• Short acting (i.e. effective for 1 to 1.5 hours so may need to be given more frequently than other opioids)
• Equianalgesic dose: 150 micrograms fentanyl SC ≈ 10mg morphine SC

Haloperidol

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Delirium (PBS)
• Psychosis (PBS)
• Terminal agitation / restlessness (PBS)
• Nausea (PBS)
• Vomiting (PBS)

Comments

• Recommendation: low initial dosing and frequent reassessment
• Antiemetic doses are lower than antipsychotic doses
• Consult specialist palliative care service for more detailed information regarding dosage
• Observe for extrapyramidal side effects e.g. akathisia (restlessness, constant motion)

HYDROmorphone

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication


• Pain (PBS)
• Shortness of breath (PBS)

Comments

• HYDROmorphone is 5 times stronger than morphine; use in consultation with specialist palliative care service
• Synthetic form of morphine
• Potential for medication errors due to confusion with morphine
• Equianalgesic dose: 2mg HYDROmorphone SC ≈ 10mg morphine SC

Hyoscine BUTYLbromide

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Respiratory secretions at end-of-life

Comments

• Most frequently used to treat respiratory secretions. Most effective if given early (i.e. as soon as ‘noisy respirations’ begin)

Metoclopramide

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Nausea (PBS)
• Vomiting (PBS)

Comments

• Observe for extrapyramidal side effects e.g. akathisia (restlessness, constant motion)

Midazolam

Usual route of administration

• Subcutaneous bolus
• Sublingual bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Anxiety
• Seizures
• Terminal agitation / restlessness
• Sedation

Comments

• Rapid onset, short acting benzodiazepine

Morphine

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Pain (PBS)
• Shortness of breath (PBS)

Comments

• Can cause confusion, myoclonus and other effects of opioid toxicity in patients with poor renal function
• Equianalgesic dose: 5mg morphine SC ≈ 15mg morphine oral
  
  

Helpful Resources

• Websites
  • Australian Medicines Handbook (AMH)
    Current (restricted access, subscription required)
  • Therapeutic Guidelines: Palliative Care V4
    2016 (restricted access, subscription required)

• Documents
  • Caring at Home and the Australian and New Zealand Society of Palliative Medicine (ANZSPM)
    Community End-of-Life Medicines List (136kb pdf).