To treat pain, dyspnea, excess oral secretions, and agitation that might occur during dying, the following medications are ordered for Mrs. G:
- Morphine IV infusion 2mg/hour. (Calculation of equianalgesic dose of currently used opioids: at home, Ms. G is on MS Contin, 60 mg q12, now unable to swallow; 60 mg q 12 = 120 mg/24 hours oral morphine = 40 mg IV morphine/24 hours = approximately 2 mg/hr IV infusion basal rate).
- For breakthrough pain or dyspnea: bolus 1-3 mg every 10-20 minutes as needed (a bolus dose of 50% - 150% of the hourly rate is a place to start).
- Glycopyrrolate (Robinul) 0.2 mg , IV every 1 min as needed for excess oral secretions or “death rattle”.
- Haloperidol 0.5-2 mg IV every 1 hour as needed for agitation (benzodiapenes could also be used, but sometimes cause paradoxical worsening of delirium).