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Palliative Care > 1: Symptom Control > Flashcards

1: Symptom Control Flashcards

1
Q

What is anticipatory prescribing

A

Prescribing based on symptoms you would expect individual to experience in last 12-months of life

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2
Q

What is given for pain in palliative care

A

Opioids

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3
Q

What opioids are given if someone has impaired renal function

A

Fentanyl

Alfentanyl

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4
Q

If someone is palliative what do NICE recommended is offered in terms of opioids

A
  • Modified release opioids

- Immediate release opioids (IR) with breakthrough

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5
Q

What is preferred method of giving opioids

A

Oral

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6
Q

What should be given with opioids in all patients

A

Laxatives. May need anti-emetics if nauseous

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7
Q

If needing to increase dose of opioids, what should it be increased by

A

30-50%

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8
Q

What do SIGN recommend is given for pain due to metastses

A

Bisphosphonates
Radiotherapy
Opioids

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9
Q

If someone has colicky abdominal pain, what is given

A

Hyoscine butylbromide

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10
Q

What is hyoscine butyl bromide also known as

A

Buscopan

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11
Q

How are hiccups in palliative care managed

A

Chlorpromazine

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12
Q

What is an alternative to chlorpromazine for hiccups

A

Haloperidol

Gabapentin

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13
Q

If someone has hepatic lesions and hiccups what is used as an alternative

A

Dexamethasone

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14
Q

If someone is agitated what is first-line

A

Find cause of agitation

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15
Q

What can be given if someone is agitated acutely

A

Haloperidol

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16
Q

In terminal phases, what is given for agitation

A

Midazolam

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17
Q

What are conservative methods to stop fluid overload

A

Stop IV Fluids and SC injection

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18
Q

What medications are indicated for fluid-overload in palliation

A

Hyoscience butyl bromide

Glycopyrronium bromide

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19
Q

What often happens in last few days of life

A

Individuals may experience a death rattle. More troubling for patients, opposed to relatives

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20
Q

What is first-line for nausea and vomiting in palliative care

A
  • Haloperidol
  • Cyclizine
  • Metclopramide
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21
Q

If nausea and vomiting is due to bowel obstruction in palliative care, what is first-line

A

Metclopramide

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22
Q

If metabolic cause of N+V, what is first-line

A

Haloperidol

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23
Q

If raised ICP, what is given to stop N+V

A

Cyclizine

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24
Q

When should cyclizine not be given

A

Glaucoma

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25
Q

What is indicated for breathlessness in palliative care

A

Midazolam
Opioids
Fan therapy

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26
Q

What is a conservative measure to improve breathlessness in palliative care

A

Fan therapy

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27
Q

What is fan therapy

A

If individuals are struggling with sensation of breathlessness, holding a hand-held fan can help

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28
Q

What is first-line for constipation

A

Sodium docasate and Senna

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29
Q

What is the role of sodium docasate

A

Faecal sofnter

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30
Q

What is the role of senna

A

Stimulant

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31
Q

What is an alternative to sodium docasate and Senna

A

Laxido (Lactulose)

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32
Q

If patients are constipated and vomiting what is indicated

A

Phosphate enema

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33
Q

Define nociceptive pain

A

Pain due to actual or perceived tissue damage

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34
Q

What are two types of nociceptive pain

A

Somatic

Visceral

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35
Q

What is somatic pain

A

Continuous ache
Worse on movement
Easily localised

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36
Q

What is visceral pain

A

Deep cramping pain

Poorly localised

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37
Q

What is neuropathic pain

A

Pain caused by damage to somatosensory system

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38
Q

What is used to assess neuropathic pain

A

Lanns assessment tool

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39
Q

What score on Lanns assessment tool indicates neuropathic pain

A

> 12

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40
Q

What % of cancer pain is neuropathic

A

20

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41
Q

What. % cancer pain is mixed

A

40

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42
Q

What is total pain

A

Individuals end perception of pain depends on physical, psychological, social and spiritual factors

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43
Q

What is breakthrough pain

A

Transient exacerbation of pain, when general pain is stable

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44
Q

When may breakthrough pain occur

A

Can occur spontaneously or in response to a particular trigger

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45
Q

Explain clinical presentation of breakthrough pain

A

Sudden-onset
Severe intensity
Usually lasts 30-minutes

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46
Q

What is incident pain

A

Breakthrough pain in response to a particular trigger (eg. physiotherapy)

47
Q

How is incident pain managed

A

Give opioids 1h before

48
Q

What should be considered before prescribing for pain

A

Cause of increase pain

49
Q

What system governs pain prescribing in palliative care

A

WHO analgesia ladder

50
Q

What is step-1 on WHO analgesia ladder

A

Non-opioid: Paracetamol or Aspirin

And adjuvant

51
Q

What is step-2 on WHO analgesia ladder

A

Weak opioid: Tramadol, Codeine

And adjuvant

52
Q

What are two weak opioids

A

Tramadol

Codeine

53
Q

What is step-3 on WHO analgesia ladder

A

Strong opioids - Morphine

54
Q

What is a strong-opioid

A

Morphine

55
Q

What are pharmacological adjuvants listed in WHO analgesia ladder

A 
Gabapentin
Pregabalin
Amitriptyline 
Bisphosphonates 
Steroids
56
Q

What are non-pharmacological adjuvants listed in WHO analgesia ladder

A

TENS
Massage
Counselling
Relaxation techniques

57
Q

What does ESMO (oncology) state about analgesia

A

Analgesia for pain should be prescribed around the clock. Oral medications are always preferred except where it is not possible (eg. N+V, dysphagia)

58
Q

How should pain medication be prescribed

A

Regular prescription section opposed to PRN

59
Q

Why should pain medication not be prescribed PRN

A

As individual will only take it when they have pain and therefore will not improve

60
Q

How often should oromorph be prescribed

A

4-6 hourly

61
Q

What times is oromorph usually given

A

2pm, 6pm and 10pm

62
Q

What is first-line for individuals with severe pain

A

Morphine Sulphate

63
Q

What are the two types of morphine sulphate

A
  1. Immediate-release

2. Modified-release

64
Q

What is the duration of action of immediate release morphine sulphate

A

4-hours

65
Q

What is the liquid form of immediate-release morphine sulphate

A

Oromorph

66
Q

What is the tablet form of immediate-release morphine sulphate

A

Sevredol

67
Q

Why may sevredol be preferred

A

Improve taste compared to oromorph

68
Q

What is the lowest dose of IR morphine sulphate that can be prescribed

A

2.5mg

69
Q

Explain prescribing IR morphine sulphate

A

Prescribe at lowest possible dose (2.5mg) and increase

70
Q

What is the duration of action of modified-release morphine sulphate

A

12hrly

71
Q

What are the MR-morphine sulphate capsules called

A

Zomorph (capsules)

72
Q

What are MR-morphine sulphate tablets called

A

MST (morphine slow-release tablets)

73
Q

Name another strong opioid

A

Oxycodone

74
Q

How can oxycodone be given

A

IR, MR, Injectable

75
Q

When is oxycodone preferable to morphine

A

GFR <30

76
Q

When should oxycodone not be given and why

A

Liver Impairment

As oxycodone depends on liver for oxidation

77
Q

If patients have GFR <30 and liver impairment, what is given as an alternative to oxycodone

A

Alfentanil

78
Q

How is alfentanil given

A

Injectable

79
Q

What are indications for alfentanil

A

GFR <15

80
Q

Name another strong opioid

A

Diamorphine

81
Q

When should opioid patches NOT be given

A

If someones pain is unstable

82
Q

When are opioid patches beneficial

A

Unable to take opioids orally

83
Q

What two opioids can be given in patches

A

Buprenorphine

Fentanyl

84
Q

What are the two buprenorphine patches

A
  • Butrans

- Transtec

85
Q

How often should butrans be changed

A

7-days

86
Q

How often should transtec be changed

A

96-hours

87
Q

How often should fentanyl be changed

A

72-hours

88
Q

When doing opioid calculations what opioid should you always covert back to

A

Convert back to morphine

89
Q

What is the ‘relative potency’ of morphine

A

1

90
Q

What is the ‘relative potency of oxycodone’

A

Oxycodone is twice as strong as morphine. Therefore relative potency compared to morphine is 2

91
Q

If wanting to convert oxycodone to morphine what should you do and why.

A

Multiply by 2.

As oxycodone is twice are strong as morphine. Twice-dose of morphine would be required to equal the same dose of oxycodone.

92
Q

Explain potency of tramadol and codeine

A

Tramadol and codeine are 1/10 as potent as morphine.

93
Q

If wanting to covert tramadol and codeine to morphine what do you do and why

A

Divide by 10.

If had 10mg Tramadol/Codiene, it would only contain 1mg of moprhine.

94
Q

How do you convert oral morphine to SC morphine

A

Divide by 2

95
Q

How do you convert oral oxycodone to SC oxycodone

A

Divide by 2

96
Q

What should be prescribed in addition to regular opioids

A

PRN for breakthrough pain

97
Q

How is breakthrough pain calculated

A

1/6 24h opioid dose

98
Q

What is the maximum allowed dose for PRN prescriptions

A

3 PRN in 4h

99
Q

If more than 3 breakthrough doses of opioids what should be done

A

Review cause for increased pain

100
Q

What doses does morphine come in

A

2.5mg, 5mg, 7mg

101
Q

What are syringe drivers

A

Continuous SC dose of opioid

102
Q

When are syringe drivers indicated

A
  • N+V
  • Poor oral absorption
  • Dysphagia
103
Q

What is the initial side effect of syringe drivers

A

N+V

104
Q

How do you calculate dose for syringe drivers

A

Divide by 2

105
Q

What are 4 common initial side-effects of opioids

A
  1. Drowsiness
  2. Unsteadiness
  3. N+V
  4. Delirium
106
Q

What are 3 common ongoing side effects

A
  1. N+V
  2. Dry mouth
  3. Constipation
107
Q

What are 5 occasional side-effects of opioids

A
  1. Hallucinations
  2. Myoclonus
  3. Urinary retention
  4. Pruritus
  5. Sweating
108
Q

What are 2 rare side effects of opioids

A

Psychological depression

Respiratory depression

109
Q

What should opioids be prescribed with

A

Laxative and anti-emetic

110
Q

What is often used as laxative with opioids

A

Senna (stimulant) and sodium docusate (stool softner)

111
Q

What is used to determine if someone is constipated

A

Rome IV criteria

112
Q

What usually precipitates opioid toxicity

A

Sepsis or AKI

113
Q

What are features of opioid toxicity

A
  • Drowsy
  • Confused
  • Myoclonic jerkes
  • Hallucinations
  • Resp depression

Palliative Care (4 decks)

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