Appendix 3: Useful drugs for the doctor's bag - Oxford Scholarship Jump to ContentJump to Main Navigation
Palliative Care in the Home$

Derek Doyle and David Jeffrey

Print publication date: 2000

Print ISBN-13: 9780192632272

Published to Oxford Scholarship Online: November 2011

DOI: 10.1093/acprof:oso/9780192632272.001.0001

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(p.160) Appendix 3: Useful drugs for the doctor's bag

(p.160) Appendix 3: Useful drugs for the doctor's bag

Source:
Palliative Care in the Home
Publisher:
Oxford University Press

What a doctor carries in his or her emergency bag usually reflects their personality and place of practice. Sadly, in some areas, the contents may have to be constrained as a security precaution against criminals and addicts. Few drugs used in palliative care will need to be carried by the doctor whose patients all live within a relatively short distance from the surgery or health centre. On the other hand, a doctor serving a widely scattered rural population may have to carry sufficient drugs to deal with a large range of emergencies.

The suggestions here are for drugs that might either be carried or kept readily available in health centres or community hospitals. We stress again that emergencies do occur in palliative care and how well they are managed affects not only the patient but also the morale and confidence of the relatives.

Diamorphine 30 milligram ampoules

It is critically important that the doctor has available a dose of strong opioid to control breakthrough or incident pain. Remember that some patients will be on high doses of opiates and the breakthrough dose needs to be calculated to reflect this (see Chapter 3).

It should go without saying that a supply of transdermal or oral opioids need not be carried for pain crises.

Dexamethasone 4 milligram ampoules

Maybe required for cerebral oedema, spinal cord compression, or superior vena caval obstruction pending admission and definitive treatment.

Hyoscine butylbromide 20 milligram ampoules

Invaluable for death rattle in drying secretions and for the relief of colic.

(p.161) Midazolam 10 milligram ampoules

One of the most useful drugs in palliative care, it should be available for agitation, panic attacks, and convulsions.

It is usually given as a bolus subcutaneously but can be given intravenously provided the dose rate does not exceed 1 milligram per minute. It is effective for 3 hours, causes amnesia, but also has the propensity to depress respiration.

The stat dose range is 1.25–10 milligrams subcutaneously, the mean daily dose being 30–60 milligrams subcutaneously in 24 hours.

Diazepam rectal solution 10 milligram tubes

This can be administered by relatives, and is effective within 15 minutes.

Haloperidol 5 milligram ampoules

Haloperidol is a useful antiemetic for drug-induced vomiting and has the added benefit of being a tranquillizer. The antiemetic dose is 1.5–2.5 milligrams.

When given for acute paranoid psychotic episodes 5–10 milligrams may be needed in a single dose. Haloperidol has a long half-life so a single dose may last 24 hours.

Methotrimeprazine 25 milligram ampoules

This phenothiazine is both antiemetic and sedative. In low doses of 6.25–12.5 milligrams it has an antiemetic effect without much sedation. However, if sedation is required then an injection of 25–50 milligrams may be given subcutaneously.

Cyclizine 50 milligram ampoules

This is a useful broad-spectrum antiemetic which is helpful in controlling vomiting due to subacute intestinal obstruction.