Medication Resources
How to Administer Oral Liquid Medications
How to Draw Up Oral Liquid Medications Using a Syringe
When administering oral liquid medications, it may be necessary to use a plastic syringe. An oral syringe can help provide an accurate measurement of the medication to ensure that the patient is getting the right dose when it is administered.
Do not substitute household items, such as household baking spoons, teaspoons, or measuring cups for dosing devices. Using household items could put the patient at risk of getting the wrong amount of medication.
Always review the medications instructions on the bottle and administer medications per the healthcare provider’s instructions.
Preparing The Syringe
- Wash your hands.
- Shake the bottle well prior to opening, unless stated otherwise on the bottle label.
- Remove the cap on the bottle. Insert the bottle syringe adapter if available. Insert the tip of the oral syringe into the bottle adapter.
- Turn the bottle upside down and pull the plunger of the syringe until the medication reaches the volume required.
- The top of the plunger should be at the desired measurement line for the correct dose.
Note: If there is no bottle syringe adapter available, place the bottle on a flat surface. Put the syringe into the opening of the bottle and make sure the tip of the syringe is in the liquid. Pull the plunger back until you have drawn the volume of medication required.
Removing Air From The Syringe
- Turn the syringe so the tip is pointing toward the ceiling.
- Tap the syringe to move the air bubbles to the top of the syringe.
- Slowly push the plunger until the air bubbles are gone.
Cleaning The Syringe
Wash the syringe after each medication administration. Separate the syringe plunger and barrel and wash each section in warm, soapy water. Rinse the syringe. Allow the syringe sections to dry naturally away from heat and sunlight then re-assemble the syringe ready for the next dose.
Contact HopeWest at any time for assistance or if you have additional questions.
A Registered Nurse is available 24/7 including after hours, weekends, and holidays.
How to Crush Medications
How to Crush Medication Properly and Safely
- If you have difficulty swallowing pills and there are no liquid or syrup formulations available, crushing pills may be a reasonable option to help with ease of swallowing.
- Before crushing a pill, ALWAYS confirm with your nurse, pharmacy, and/or healthcare provider that it is safe and appropriate to do so.
Do Not Crush a Pill If:
- The pill is enteric coated: These medications will commonly have EN or EC at the end of their name.
- Sustained Release/Extended Release pills: These medications will commonly have CR, ER, XL, or XR at the end of their names.
- There is no score mark on the pill: A groove or line on the pill indicates that the medication is safe to split apart and/or crush.
- The label on your medication bottle indicates that the medication cannot be chewed or crushed.
Recommended Pill Crushing Devices
Pill Crusher
Most pill crushers are handheld devices that you twist to grind a pill into a fine powder. Others look like a stapler or garlic press that you grip to crush the pill.
Mortar and Pestle
A mortar is a cup-shaped bowl and a pestle is a club-shaped tool used to grind the pill manually.
Pill Splitter
This handheld device does not crush pills but can split them into halves or quarters so that they are easier to swallow
Administration of Crushed Medication
Pills should be crushed into a fine powder. The medication can be dissolved in a small amount of water or mixed into a small amount of soft food. This ensures you are given the complete dose prescribed by your healthcare provider.
Crushed medication can also be mixed with a small amount of water and drawn up into an oral syringe to be administered under the tongue or against the cheek for ease of swallowing.
Contact HopeWest at any time for assistance or if you have additional questions.
A Registered Nurse is available 24/7 including after hours, weekends, and holidays.
Haloperidol Medication
What is Haloperidol and Why is it Prescribed?
Haloperidol is a medication that is prescribed in hospice to relieve and reduce symptoms of nausea and vomiting, agitation, restlessness, and psychosis. This medication can be prescribed in oral liquid, tablet, or injectable forms and can be ordered as a scheduled medication (to use on a daily basis), or to use on an “as needed” basis if you have immediate or sudden symptoms.
What Are Common Side Effects of Haloperidol?
Some side effects you may experience include:
- Drowsiness & Fatigue: This side effect may occur initially and is usually temporary, subsiding a few days after your body adjusts to the medication.
- Dizziness & Unsteadiness: Use caution when walking. When you are changing position (lying to sitting, sitting to standing), move slowly to give your body time to adjust to the change in position. If symptoms continue or get worse, tell your nurse.
- Stiffness or Trembling: This side effect may be related to dopamine levels in the body. If you experience this side effect, tell your nurse right away.
- Some patients have a sensitivity to Haloperidol, and this sensitivity can cause an increase in symptoms such as agitation, restlessness, or excitement. Tell your nurse right away if you experience this side effect.
How Do I Take This Medication?
- Be sure to follow the directions given by your provider. Never use Haloperidol in larger amounts than prescribed.
- Haloperidol tablets may be crushed and mixed with a small amount of liquid or food if you have difficulty swallowing, or an oral liquid form can be ordered.
- A HopeWest nurse will show you how to measure oral liquid medication. The measured dose can be administered under the tongue or against the cheek for ease of swallowing.
What This Medication Will Not Do When Taken As Prescribed:
- When taking Haloperidol as prescribed, this medication will not hasten death and it will not cause addiction.
- As your disease progresses, your body may develop a tolerance to this medication and you may require an increase in your dosage to effectively treat symptoms.
Contact HopeWest at any time for assistance or if you have additional questions.
A Registered Nurse is available 24/7 including after hours, weekends, and holidays.
Hydromorphone Medication
What Is Hydromorphone And Why Is It Prescribed?
Hydromorphone is an opioid medication used in hospice to relieve and reduce symptoms of pain, shortness of breath, cough, or chest pain. This medication can be prescribed in oral liquid, tablet, or injectable forms. Hydromorphone is used as a short-acting medication, meaning it is used for immediate relief of symptoms.
Why Did My Medical Provider Order Two Different Types Of Opioids?
Long-acting opioids are not effective in treating a sudden episode of pain or shortness of breath because it is a time-released medication. Long-acting medications may be needed in addition to a short-acting medications like Hydromorphone in order to completely and effectively manage symptoms.
What Are Common Side Effects Of Hydromorphone?
- Drowsiness & Fatigue: This side effect may occur initially and is usually temporary, subsiding a few days after your body adjusts to the medication.
- Constipation: Opioid-Induced-Constipation is common. To reduce the risk of this symptom, HopeWest will start a bowel medication to be taken while using morphine. If you still experience constipation while using morphine and a bowel medication, tell your nurse.
- Nausea: This side effect may initially occur, but tends to wear off after a few days of taking the medication. Taking our medication with a light snack may help reduce nausea symptoms.
- Dizziness: To reduce the risk of falls, change position slowly when getting up. If this symptom persists, tell your nurse.
How Do I Take This Medication?
- Be sure to follow the directions given by your medical provider. Never use Hydromorphone in larger amounts than prescribed.
- A HopeWest nurse will teach you or your caregiver how to safely measure oral liquid medication. Oral liquid doses can be administered under the tongue or against the cheek for ease of swallowing.
What This Medication Will Not Do When Taken As Prescribed:
- When taking Hydromorphone as prescribed, this medication will not hasten death and it will not cause addiction.
- As your disease progresses, your body may develop a tolerance to this medication and you may require an increase in your dosage to effectively treat symptoms.
Contact HopeWest at any time for assistance or if you have additional questions.
A Registered Nurse is available 24/7 including after hours, weekends, and holidays.
Lorazepam Medication
What Is Lorazepam And Why Is It Prescribed?
Lorazepam is a medication that is prescribed in hospice to help relieve and reduce symptoms of anxiety, insomnia, agitation and restlessness, shortness of breath, and seizure management. This medication can be prescribed in oral liquid, tablet, or injectable forms. This medication can also be ordered as a scheduled medication (to use on a daily basis), or to use on an “as needed” basis if you have immediate or sudden symptoms.
If You Have Been Prescribed Lorazepam Oral Liquid, Please Note:
Oral liquid Lorazepam is a perishable medication and must be stored in the refrigerator. Once a bottle of oral liquid Lorazepam is opened, the medication is only good for 30 days. To keep track of the bottle’s shelf life, you should use a pen or marker to label the bottle with the date that it was opened. If the seal on the top of the bottle has not been broken and the medication remains refrigerated, Lorazepam will not expire until the stamped manufacturer date on the bottle.
What Are Common Side Effects Of Lorazepam?
- Drowsiness & Fatigue: This side effect may occur initially and is usually temporary, subsiding a few days after your body adjusts to the medication.
- Dizziness & Unsteadiness: Use caution when walking. When you are changing position (lying to sitting, sitting to standing), move slowly to give your body time to adjust to the change in position. If symptoms continue or get worse, tell your nurse.
- Some patients have a sensitivity to Lorazepam, and this sensitivity can cause an increase in symptoms such as anxiety, restlessness, or excitement. Tell your nurse right away if you experience this side effect.
How Do I Take This Medication?
- Be sure to follow the directions given by your provider. Never use Lorazepam in larger amounts than prescribed.
- Lorazepam tablets may be crushed and mixed with a small amount of liquid if you have difficulty swallowing, or an oral liquid form can be ordered.
- A HopeWest nurse will show you how to measure oral liquid Lorazepam. The measured dose can be administered under the tongue or against the cheek for ease of swallowing.
What This Medication Will Not Do When Taken As Prescribed:
- When taking Lorazepam as prescribed, this medication will not hasten death and it will not cause addiction.
- As your disease progresses, your body may develop a tolerance to this medication and you may require an increase in your dosage to effectively treat symptoms.
Contact HopeWest at any time for assistance or if you have additional questions.
A Registered Nurse is available 24/7 including after hours, weekends, and holidays.
Methadone Medication
What Is Methadone And Why Is It Prescribed?
Methadone is an opioid medication that is used in hospice for the treatment of severe and complex pain. It is also the only opiate that can specifically target neuropathic pain. This mediation can be prescribed in tablet or oral liquid forms. It is often ordered as a scheduled medication to reduce the severity of chronic symptoms, and you may still need an additional short-acting opioid medication for the treatment of sudden or urgent symptoms. Although Methadone has been used in some settings as a replacement therapy for addiction treatment, the intended purpose of this medication is to treat pain.
What Are Common Side Effects Of Methadone?
Some side effects you may experience include:
- Drowsiness & Fatigue: This side effect may occur initially and is usually temporary, subsiding a few days after your body adjusts to the medication.
- Constipation: Opioid-Induced-Constipation is common. To reduce the risk of this symptom, HopeWest will start a bowel medication to be taken while using morphine. If you still experience constipation while using morphine and a bowel medication, tell your nurse.
- Nausea: This side effect may initially occur, but tends to wear off after a few days of taking the medication. Taking our medication with a light snack may help reduce nausea symptoms.
- Dizziness: To reduce the risk of falls, change position slowly when getting up. If this symptom persists, tell your nurse.
How Do I Take This Medication?
- Be sure to follow the directions given by your provider. Never use Methadone in larger amounts than prescribed.
- Methadone tablets may be crushed and mixed with a small amount of liquid or food if you have difficulty swallowing, or an oral liquid form can be used.
- A HopeWest nurse will show you how to measure liquid medication. The measured dose can be administered under the tongue or against the cheek for ease of swallowing.
- It is important not to miss or skip doses of Methadone. If you forget to take a dose, call HopeWest.
What This Medication Will Not Do When Taken As Prescribed:
- When taking Methadone as prescribed, this medication will not hasten death and it will not cause addiction.
- As your disease progresses, your body may develop a tolerance to this medication and you may require an increase in your dosage to effectively treat symptoms.
Contact HopeWest at any time for assistance or if you have additional questions.
A Registered Nurse is available 24/7 including after hours, weekends, and holidays.
Morphine Medication
What Is Morphine and Why Is It Prescribed?
Morphine is an opioid medication used in hospice to relieve and reduce symptoms of pain, shortness of breath, cough, or chest pain. This medication can be prescribed in oral liquid, tablet, or injectable forms, and is also available as either a short-acting or a long-acting medication. What this means is that the short-acting medication is used for immediate relief of symptoms, while the long-acting medication is used to manage chronic symptoms.
Why Did My Medical Provider Order Two Different Forms Of Morphine?
Long-acting morphine is not effective in treating a sudden episode of pain or shortness of breath because it is a time-released medication. Short-acting Morphine may still need to be used to manage urgent and/or breakthrough pain or shortness of breath symptoms.
What Are Common Side Effects Of Morphine?
- Drowsiness & Fatigue: This side effect may occur initially and is usually temporary, subsiding a few days after your body adjusts to the medication.
- Constipation: Opioid-Induced-Constipation is common. To reduce the risk of this symptom, HopeWest will start a bowel medication to be taken while using Morphine. If you still experience constipation while using morphine and a bowel medication, tell your nurse.
- Nausea: This side effect may initially occur, but tends to wear off after a few days of taking the medication. Taking our medication with a light snack may help reduce nausea symptoms.
- Dizziness: To reduce the risk of falls, change position slowly when getting up. If this symptom persists, tell your nurse.
How Do I Take This Medication?
- Be sure to follow the directions given by your medical provider. Never use Morphine in
larger amounts than prescribed. - When using long-acting tablets, be sure to take according to the timed increments as prescribed. For example, if the directions say, “Take every 12 hours”, take your medication at a 12-hour interval that works for your schedule such as 8:00 a.m. and 8:00 p.m. NEVER crush or chew long-acting tablets.
- A HopeWest nurse will teach you or your caregiver how to safely measure liquid medication. Oral liquid doses can be administered under the tongue or against the cheek for ease of swallowing.
What This Medication Will Not Do When Taken As Prescribed:
- When taking Morphine as prescribed, this medication will not hasten death and it will not cause addiction.
- As your disease progresses, your body may develop a tolerance to this medication and you may require an increase in your dosage to effectively treat symptoms.
Contact HopeWest at any time for assistance or if you have additional questions.
A Registered Nurse is available 24/7 including after hours, weekends, and holidays.
Symptom Management Without Medications
Anxiety & Worry
- Create a calm & quiet environment. Decrease over-stimulation
- Provide active listening, validation, & reassurance without judgment
- Distraction: Go for a walk or wheelchair ride, reminisce, watch a favorite movie, listen to music, etc.
- Relaxation: Encourage slow & deep breathing, meditation, or guided imagery
- Use essential oils/lotions like lavender, sandalwood, or lemon*
- Offer a caring touch, such as holding hand or hand on shoulder
Confusion & Agitation
- Create a calm & quiet environment. Decrease over-stimulation
- Offer redirection & reassurance using a calm & steady voice
- Explain what you are going to do before you do it
- Avoid startling, rushing, or arguing. Avoid physical touch without permission
- Relaxation: Encourage slow & deep breathing, meditation, or guided imagery. Adjust lighting
- Distraction: Go for a walk or wheelchair ride, reminisce, watch a favorite movie, listen to music, etc.
- Develop a routine: Keep a regular schedule for meals, care, activities, & bedtime
- Keep surroundings familiar and keep familiar items close
- Use essential oils/lotions like lavender, sandalwood, or lemon*
Dry Mouth & Lips
- Perform oral care often & clean dentures often
- Use mouth moisturizer sprays and/or ointments
- Offer lozenges, sugar-free candy, or chewing gum as tolerated
- Offer ice chips as tolerated
Insomnia
- Open window blinds or curtains during the day to let in natural light
- Create a calm, cool, dark, & quiet environment at night
- Develop & maintain a consistent bedtime routine & sleep schedule
- Decrease stimulation 30 minutes prior to going to bed
- Minimize liquids & avoid caffeine later in the day
- Relaxation: Encourage slow & deep breathing, meditation, or guided imagery
- Use essential oils/lotions like lemon or orange during the daytime, & lavender or chamomile at bedtime*
- Use of white noise such as rain or calming environmental sounds
Nausea & Vomiting
- Avoid spicy, greasy, & fried foods
- Avoid strong smells & eliminate odors in the room
- Offer foods that are gentle on the stomach: Bananas, rice, applesauce, toast, saltine crackers, tea, ginger ale, & peppermint candy
- Encourage small frequent meals instead of large meals
- Circulate cool air with use of a fan or open window
- Apply cool wash cloth on forehead, back of neck, or wrists
- Perform frequent oral care
- Use essential oils/lotions like peppermint, ginger, or lavender*
Shortness of Breath
- Circulate cool air with use of a fan or open window
- Elevate head of bed or sit up in a chair. Avoid lying flat
- Sit in tripod position: Lean forward with hands and/or elbows resting on knees or table
- Try pursed lip breathing: Breathe in through your nose, & blow air out through your mouth
- Relaxation: Encourage slow & deep breathing, medication, or guided imagery
- Conserve energy between activities
- Create a calm & cool environment
Pain
- Reposition for comfort: Use pillows, blankets, or wedges. A hospital bed can be provided
- Use of heat or cold therapy**
- Distraction: Storytelling & reminiscing, watch a favorite movie/show, listen to music, white noise, etc.
- Relaxation: Encourage slow & deep breathing, meditation, or guided imagery. Adjust lighting
- Therapeutic Touch: Offer gentle massage, pillow bracing, gentle stretching & movement
- Use essential oils like lavender, peppermint, or chamomile*
*Always verify allergies & skin sensitivities prior to use of essential oils
**Never place a heating pad or ice pack directly onto bare skin
Contact HopeWest at any time for assistance or if you have additional questions.
A Registered Nurse is available 24/7 including after hours, weekends, and holidays.
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