Palliative Care Work

Question 1

What is Palliative Care defined as?

Answer 1

An approach that improves the quality of life of patients and their families facing the problems
associated with life-threatening illness, through the prevention and relief of suffering by
means of early identification and impeccable assessment and treatment of pain and
other problems, physical, psychosocial and spiritual

Question 2

What is unlicensed medicine?

Answer 2

Medicine without a European or UK marketing authorisation for use in humans and is not licensed to be marketed in the UK.

Question 3

What is off-license/off-label medicine?

Answer 3

Licensed medicine used for unlicensed applications, e.g. an unlicensed indication, an unlicensed route or at an
unlicensed dose

Question 4

Nausea and vomiting: Which receptors are responsible for chemoreceptor trigger zone?

Answer 4

D2 and 5HT3

Question 5

Nausea and vomiting: Which receptors are responsible for Higher Centres? (anxiety/raised ICP)

Answer 5

H1

Question 6

Nausea and vomiting: Which receptors are responsible for vestibular input? (Motion sickness)

Answer 6

Ach and H1

Question 7

Nausea and vomiting: Which receptors are responsible for GI tract?

Answer 7

D2 and 5HT3

Question 8

What is Haloperidol good for in N+V?

Answer 8

D2 receptor antagonist. Used in chemical causes of nausea & vomiting (N&V) e.g. opioids
Avoid in parkinsons

Question 9

What is Domperidone & Metoclopramide good for in N+V?

Answer 9

D2 receptor antagonist. Metoclopramide also acts on 5HT4 & 5HT3 at higher doses. Used where N&V is caused by gastric stasis and ileus or for delayed chemotherapy induced N&V

Question 10

What is Levomepromazine, Prochlorperazine good for in N+V?

Answer 10

Dopamine, H1 and Ach-receptors antagonist with varying degrees of efficacy. Wide-ranging mode of action, used when non-specific or multi-factorial causes of N&V

Question 11

What is Cyclizine, Cinnarizine, Promethazine good for in N+V?

Answer 11

Act on H1-receptors, centrally and peripherally. Used in cases of obstruction, peritoneal irritation, vestibular causes (motion sickness), raised intra-cranial pressure

Question 12

What is Granisetron, Ondansetron good for in N+V?

Answer 12

5-HT3-receptors antagonist. Used in chemotherapy and radiotherapy induced N&V, post-operative
N&V

Question 13

What are the mechanism of actions of opioids and benzodiazepines in breathlessness?

Answer 13

Opioid: Mechanism of action not fully understood but opioids reduce the ventilatory
response to hypercapnia, hypoxia and exercise, decreasing respiratory effort
and dyspnoea

Benzodiazepine: Not first line (limited evidence). May be considered where anxiety/panic is a
component (Anxiolytic - reduce perception of breathlessness)

Question 14

Palliative Care Bleeding: Mild/Moderate Bleeding Management?

Answer 14

Systemic treatment for surface bleeding from any site: tranexamic acid
1g PO TDS-QDS

Topical treatment for fungating wounds and anterior epistaxis: gauze
soaked in adrenaline 1:1000 or tranexamic acid 500mg/5ml injection
solution. Apply with pressure for 10 minutes

Topical treatment for oral bleeding: tranexamic acid 500mg/5ml
mouthwash/gargle at a dose of 5-10ml QDS

Question 15

Palliative Care Bleeding: Major Bleeding Management?

Answer 15

The most important is to stay with the patient. Talk to and comfort them.
If the bleed is visible, dark coloured towels can make the appearance of
the blood less frightening

Consider giving midazolam 5-10mg IV/IM/SC to reduce awareness and
fear

Question 16

What could be used if patients cannot tolerate codeine?

Answer 16

Tramadol