Which drug to give..........and why????

EDRN-2010 · Nov 9, 2009

Are you sure the route is sub Q? My first inclination was to give the Midazolam because it is a anxiolytic that has been used in palliative patients to reduce agiitation. The only reason I hesitate is because of the sub Q. My drug guide does not say anything about giving it subQ although when I google it I get a ton of hits of using it on a subQ infusion in cases like this....

The hyoscine/hyoscamine sulfate is an antispaspotic for GI disorders...morphine is commonly given in a situation like this when there is pain but you do not mention pain? I would say if the person is in pain that morphine would help ease the pain and decrease restlessness. Sorry if I am not much help!

I have been given a scenario, and I have to make a choice of which medication I would give, and why:
You have a palliative patient who is in the end stages, and he is quite restless and agitated. If you are given the choice of three PRN meds, which would you give, and why:
1. Morphine 5mg s/c
2. Midazolam 5mg s/c
3. Hyoscine 0.4mg s/c

Would someone be kind enough to enlighten me on this. I'm only new to all these meds!! Sorry.......

belle87RN · Nov 9, 2009

I'm an not familiar with the second two drugs but I am familiar with morphine, and we had a representative from our local hospice care in our nursing class last week. She talked about a lot of times these patients that are in end stage disease often are agitated and restless because they are in pain and are unable to tell us for some reason or another so they do have standing orders to give morphine to their patients. So from what she said and not really being familiar with the other two, I would lean toward the morphine.

Sarah Hay · Nov 9, 2009

I'd choose morphine.

donnaclure · Nov 9, 2009

Yes, the three meds are all supposed to be given by Sub Q, that's the indications.

I've been researching it a bit, and I know that Hyoscine is not really an option. But I'm torn between whether morph, or Midaz is the best option.....and why it would be the best option.

allnurses Guide · Nov 9, 2009

Morphine, morphine, and then some more morphine. In palliative care, restlessness/agitation is often due to unremitting pain - morphine 5mg s/c is not a big dose but should settle the patient.

Midazolam will sedate but not fix the problem. Hyoscine will not help.

ayla2004, ASN, RN · Nov 10, 2009

The 1st rwo morphine s/c and midazalom s/c are pallative end of life drugs in the UK.

I had to make the decison between the 2 for a pt who seemed agigtated as a new RN, i choose morphine as sedating a pt who may be in pian would be wrong. if they were still agigtated id give midazalom and reasses if more morphine needed.

oh and if a pt appears to have air hunger morphine represses respiatory drive and this seems to reduce agigation as well.

L&DWannaB · Nov 10, 2009

Were you given a diagnosis? Cancer, GI etc... that would help narrow down what drug to give. Palliative care doesn't always tell me what it is since certain drugs are used for different Diagnosis'

leia_spn · Nov 11, 2009

I would choose morphine. I just spent a clinical day in Onc.. The end stage patients we saw were agitated and restless but also in severe pain. Morphine would be a better choice becuase by reducing their pain level it may in turn reduce their agitation and restlessness.

loriangel14, RN · Nov 11, 2009

Where i work we give morphine for palliative agitation. The reasoningbeing that air hunger causes the restlessness and the morphine represses the respirations enough to ease the distress. Our doc usually orders 2-10mg q15min.