Palliative care

Question 1

what is palliative care
how is it done

Answer 1

approach that improves the QofL of paitnets and their families facing problems associated with life-threating illness

through prevention and relief of suffering
by early identification and assessment, treatment of pain (physical, psychosocial and spiritual)

Question 2

what is approaching end of life

Answer 2

likely to die within 12 months

Question 3

who else get end of life care

Answer 3

facing imminent death
advanced incurable conditions
general fraility
at risk of dying from sudden crisis of condition
life threatening by sudden catastrophic events

Question 4

what are principles of delivering good end of life care

Answer 4

ADVANCED and ANTICIPATORY care
preparing family and patient for death

Question 5

what are typical pain patterns for end of life patients
and pain syndromes

Answer 5

BACKGROUND
BREAKTHROUGH
INCIDENT

bone
nerve
liver
raised intracranial pressure
colic

Question 6

what pain tool do you use instead of SOCRATES

Answer 6

brief pain inventory

done for pain in last 24 hours
-acute

Question 7

what is the WHO alagesic ladder for cancer pain

Answer 7

step1
non-opioid
-paracetamol, aspirin, NSAID
with/without adjuvent

step2
weak opioid
-codeine
with/without non-opioid and adjuvent

step 3
strong opioid
-morphine
with/without non-opioid and adjuvant

Question 8

what are some step 2 drugs

Answer 8

codeine
dihydrocodeine
tramadol

Question 9

what are some drugs for step 3

Answer 9

morphine
diamorphone
fentanyl
oxycodone

Question 10

what are the two indications for morphine

Answer 10

moderate/severe pain
dyspnoea

Question 11

how does morphine act

Answer 11

act on opioid receptor agonist
centrally acting

Question 12

what are some morphine cautions

Answer 12

renal impairment
elderly

Question 13

how do you administer morphine

Answer 13

oral/rectal
IM/SC injections
syringe driver over 24 hours

Question 14

when do you use modified release morphine

Answer 14

for BACKGROUND PAIN

twice daily at 12 hour intervals
once daily at 24 hour intervals

Question 15

when do you use immediate release morphine

Answer 15

for BREAKTHROUGH PAIN

as required
-oramorph liquid
sevredol tabs

Question 16

what is diamorphine used for and why

Answer 16

semi-synthetic morphine
more soluble therefore smaller volumes needed
parenteral administation

Question 17

what are second line opioids

Answer 17

if cant tolerate morphine

oxycodone
-less hallucinatoins, itch, drowsiness, confusion

fentanyl patch
-lasts 72 hours

Question 18

what are opioid side effects

Answer 18

N and V
Constipation
dry mouth
biliary spasm

monitor for opioid toxicity

Question 19

manage opioid side effects

Answer 19

constipation
-laxative
-senna/bisacodyl and docusate
-magrogol
-co-danthramer alone

nausea
-antiemetic
-metoclopramide
-haloperidol- QT interval awareness!!!!

Question 20

what is opioid toxicity

Answer 20

shadows edge of visual field
increasing drowsiness
vivid dreams/hallucinations
muscle twitching/myoclonus
confusion
pin point pupils
rarely/ respiratory depression

Question 21

what adjuvants can you use

Answer 21

 Liver capsule pain/raised intracranial pressure – Steroids (e.g. Dexamethasone) – Remember to consider gastroprotection
 Neuropathic pain – Amitriptyline/ Gabapentin/ Carbamazepine
 Bowel/ bladder spasm
– Buscopan (Hyoscine Butylbromide)
 Bony pain/ soft-tissue infiltration – NSAIDs/ Radiotherapy for bony metastas

Question 22

what is a syringe driver used for

Answer 22

delivery over 24 hours (SC)
GOOD WHEN CANT USE ORAL
GOOD FOR RAPID control
-stigma

Question 23

what are the 4 aspects to consider with end of life care/ TOTAL PAIN care

Answer 23

PHYSICAL
SOCIAL
SPIRITUAL
PSYCHOLOGICAL

Question 24

what is psycho-social distress

Answer 24

impaired ability to experience and integrate meaning and purpose in life
through connected with seld/others/nature. power
-if individual beliefs challenged

Question 25

how did covid 19 affect grief

Answer 25

decreased professional support
strains on informal care netowrks
reduced quality of life
increased loss, grief and bereavement

Question 26

discuss the percetanges of grief from bereavement

Answer 26

90-94% grief is NON-COMPLEX

6-10% COMPLEX/ unresolved- eg. become unwell

therefore most only require support and space rather than medication

Question 27

what is most important essence of palliative and bereavement care

Answer 27

LISTENING