End of Life Care Prework

morphine

first line for PAIN and DYSPNEA

• dec air hunger by reducing resp drive and anxiety

• helps w/ terminal secretions discomfort

oxycodone

alternative opioid for moderate to severe pain when oral route is preferred and pt can still swallow

fentanyl

used in opioid-tolerant pts or those who CANNOT swallow (transdermal patch)

• good for CHRONIC PAIN CONTROL w/ steady release

midazolam

ANXIETY, AGITATION, TERMINAL RESTLESSNESS, and PALLIATIVE SEDATION when sx are refractory

• rapid acting

haloperidol

FIRST LINE for TERMINAL DELIRIUM and AGITATION

• also used for N

glycopyrrolate

reduces TERMINAL SECRETIONS (“death rattle”) without crossing BBB → less sedation / confusion

atropine drops

Sublingual drops for rapid control of noisy respiratory secretions in actively dying patients.

scopolamine

Used to manage the death rattle; dec nausea by dec mucus production 

Transdermal patch for secretions + motion-related nausea; longer duration than atropine.

prochlorperazine

treats nausea/vomiting, especially from chemical causes (e.g., meds, toxins).

promethazine

Used to treat N, V, and terminal restlessness 

Used for nausea with sedation benefit; helpful if patient is also restless.

metoclopramide

Best for gastric stasis, constipation-related nausea, or partial bowel obstruction.

dexamethasone

Multiple roles: ↓ inflammation, improves appetite, energy, helps with brain mets, spinal cord compression, and refractory nausea.

quetiapine

Manage terminal delirium, severe agitation, and anxiety (esp w/ sedation) 

Used for delirium, agitation, and insomnia when a more sedating, gentler antipsychotic is preferred.