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AKT > Palliative care + geris > Flashcards

Palliative care + geris Flashcards

1
Q

Tramadol to morphine conversion

A

divide by 10

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2
Q

DEXA scan T-scores for osteopenia and osteoporosis

A

Normal > -1
Osteopenia -1.0 - -2.5
Osteoporosis < - 2.5

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3
Q

What 3 things are DEXA scans adjusted for

A

Age
Ethnic factors
Gender

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4
Q

oral morphine to subcutaneous syringe driver morphine conversion

A

divide daily oral morphine by 2

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5
Q

Most drugs are compatible with water for injection in syringe driver, but for which 5 drugs is sodium chloride 0.9% recommended?

A

Granisetron
Ketamine
Ketorolac
Octreotide
Ondansetron

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6
Q

Cyclizine when given at high doses may be incompatible with which syringe driver pain medication

A

Diamorphine

Cyclizine is incompatible with quite a lot e.g. dexamethasone, ketamine, metoclopramide

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7
Q

When starting treatment with opioids in palliative care for advanced and progressive disease, what should be offered

A

Regular oral morphine
Modified release or immediate release

With PRN immediate release for breakthrough pain

If no comorbidities use 20-30mg MR/day with 5mg breakthrough

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8
Q

Breakthrough dose of morphine is what proportion of daily dose of morphine

A

One sixth

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9
Q

What opioid for pain relief is preferred to morphine in palliative patients with mild-mdoerate renal impairment

A

Oxycodone

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10
Q

What 3 opioids for pain relief is preferred to morphine in palliative patients with severe renal impairment

A

Alfentanil
Buprenorphine
Fentanyl

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11
Q

Metastatic bone pain may respond to which 4 options

A

Strong opioids
Bisphosphonates
Radiotherapy
Denosumab

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12
Q

When increasing the dose of opioids, the next dose should be increased by …%?

A

30-50%

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13
Q

Codeine to morphine conversion

A

Divid by 10

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14
Q

Oral morphine to oral oxycodone conversion

A

Divide by 1.5-2

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15
Q

Transdermal fentanyl 12mcg patch equates to how much oral morphine daily

A

30mg oral morphine

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16
Q

Transdermal buprenorphine 10mcg patch equates to how much oral morphine daily

A

24mg oral morphine

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17
Q

oral morphine conversion to subcutaneous (syringe driver) diamorphine

A

divide daily morphine by 3

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18
Q

conversion of oral oxycodone to subcutaneous (syringe driver) diamorphine

A

divide by 1.5

19
Q

What antiemetics can be used in palliative care for nausea + vomiting due to gastric dysmotility + stasis (bloating)

A

Metoclopramide
Domperidone

i.e. DA receptor antagonists

20
Q

Which antiemetic is preferred for raised intracranial pressure vomiting

A

Cyclizine

+/- dexamethasone, radiotherapy

21
Q

Which antiemetic is preferred for chemically mediated disturbances vomiting

A

Ondansetron
Haloperidol
Levomepromazine

22
Q

Which antiemetic is preferred for visceral/serosalvomiting

A

Cyclizine
Levomepromazine
+/- anticholinergics i.e. hyoscine

23
Q

Which antiemetic is preferred for vestibular system vomiting

A

Cyclizine

(refractory = use metoclopramide or prochlorperazine, or olanzapine or prochlorperazine)

24
Q

Which antiemetic is preferred for cortical/anticipatory nausea vomiting

A

Lorazepam or cyclizine

25
Q

What opioid is most likely to cause constipation

A

Oxycodone

26
Q

Hiccups in palliative care are treated with what 2 drugs

A

Chlorpromazine
Or haloperidol, gabapentin, dexamethasone

27
Q

Syringe drivers: respiratory secretions & bowel colic may be treated by …

A

hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide

28
Q

What to prescribe for reducing the discomfort associated with a painful mouth that may occur at the end of life

A

Benzydamine mouthwash

29
Q

commenst cause of dementia in the UK

A

Alzheimer’s disease

30
Q

MMSE cut off score for dementia

A

24/30 or less = dementia

31
Q

Visual hallucinations with dementia suggests which type of dementia

A

Lewy body dementia

32
Q

Difference between parkinsons disease and Lewy body dementia

A

LBD has progressive cognitive impairment BEFORE parkinsonism symptoms (motor tremor etc)
Cognition tends to be fluctuating
Visual hallucinations may also be seen

33
Q

Diagnosis of Lewy body dementia - what are the investigations

A

Usually clinical!

Can use SPECT

34
Q

What type of medications should be avoided in Lewy body dementia

A

Neuroleptics /anti-psychotics
Can develop irreversible parkinsonism

35
Q

Management of Lewy body dementia

A

ACh-esterase inhibitors
e.g. donepezil, rivastigmine

Memantine

(same treatment as Alzheimers!)

36
Q

First line sedative for elderly delirium as per 2006 Royal College of Physicians

A

Haloperidol 0.5mg oral

(NICE advocate haloperidol or olanzapine)

37
Q

What is management for vascular dementia

A

NO MEDICATIONS!

38
Q

treatment of alzheimer’s disease

A
  1. ACh-esterase inhibitors - donepezil, gala ntamine, rivastigmine. For mild to moderate
  2. Second line = memantine (NMDA receptor antagonist). For moderate to severe Alzheimer’s as an add on, or monotherapy in severe
39
Q

Managing non-cognitive symptoms in dementia e.g. depression, agitation

A

NICE DOES NOT RECOMMEND ANTI-DEPRESSANTS

Consider antipsychotics if agitation, hallucinations

40
Q

Donepezil contraindicated with patients who have…

A

bradycardia

SEs: insomnia

41
Q

three types of frontotemporal lobe dementia

A

Frontotemporal lobe dementia (Pick’s disease)
Progressive non-fluent aphasia (CPA)
Semantic dementia

42
Q

What score is widely used to screen for patients who are at risk of developing pressure areas?

A

The Waterlow score

43
Q

in what ages is neuroimaging needed to diagnose dementia

A

ALL AGES

44
Q

Frailty should be specifically assessed through the evaluation of gait speed, self-reported health status, or which questionnaire

A

PRISMA-7 questionnaire

AKT (25 decks)

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