Ageing and End of Life Care Flashcards Preview

Y3 Medicine for the Elderly > Ageing and End of Life Care > Flashcards

Flashcards in Ageing and End of Life Care Deck (27)
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1
Q

what is the first step in the management of pain?

A

non opioid (e.g. aspirin, paracetamol, NSAID)

+/- adjuvant

2
Q

what is the second step in the management of pain?

A

weak opioid for mild-moderate pain (e.g. codeine)

+/- non opioid
+/- adjuvant

3
Q

what is the third step in the management of pain?

A

strong opioid for moderate-severe pain (e.g. morphine)

+/- non opioid
+/- adjuvant

4
Q

what are the two options for prescribing morphine?

A

slow release - morphine sulphate M/R

immediate release - morphine sulphate I/R

5
Q

how long does morphine sulphate M/R last and when should it be taken?

A

12 hours

twice daily

6
Q

name two brands of morphine sulphate M/R

A

MST

zomorph

7
Q

how long does morphine sulphate I/R last and when should it be taken?

A

four hours

as required

8
Q

what quantity of morphine sulphate I/R should be given to a patient also on M/R?

A

1/6 of the total background dose

9
Q

name two brands of morphine sulphate I/R

A

oramorph

sevredol

10
Q

name three symptoms of opioid toxicity

A

hallucinations
myoclonus
drowsiness

11
Q

what does opioid toxicity usually respond to?

A

dose adjustment or switching to another strong opioid

12
Q

what is a severe side effect of morphine?

A

respiratory depression

13
Q

what drug can be administered to reverse morphine and what dose should be given?

A

naloxone

small doses e.g. 80mcg IV every 2 mins to avoid pain reversal

14
Q

name a commonly used second line strong opioid

A

oxycodone

15
Q

what are the two safest opioids in severe renal impairment?

A

fentanyl

alfentanil

16
Q

which is stronger - oxycodone or morphine?

A

oxycodone is TWICE as strong

if switching from morphine, half the dose

17
Q

which is stronger - oral or subcutaneous morphine and what should be done when switching between these?

A

SCUT is twice as strong

divide the total daily oral morphine dose by 2 = SCUT dose

18
Q

name some conditions that can mimic dying

A
opioid/drug toxicity
sepsis
hypercalcaemia
AKI
hypoglycaemia
19
Q

what is used when the oral route for drugs is not available at the end of life?

A

syringe drivers (CSCI)

these provide continuous subcutaneous infusion of drugs

20
Q

how many medications can be given via a syringe driver at one time?

A

up to three

21
Q

what medicine is given in anticipation of pain at the end of life?

A

morphine 2mg SCUT hourly

if established on opioids - 1/6 daily background dose

22
Q

what medicine is given in anticipation of SOB at the end of life?

A

morphine 2mg SCUT hourly

23
Q

what medicine is given in anticipation of distress at the end of life?

A

midazolam 2mg SCUT hourly

24
Q

what medicine is given in anticipation of nausea at the end of life?

A

levomepromazine 2.5mg SCUT 12 hourly

25
Q

what medicine is given in anticipation of respiratory secretions at the end of life?

A

buscopan 20mg SCUT hourly

26
Q

what needs to be observed for confirmation of a death?

A
absence of carotid pulse for 1 min
absence of heart sounds for 1 min
absence of respiratory sounds for 1 min
no response to painful stimulus 
fixed dilated pupils
27
Q

what painful stimulus is used for confirmation of death?

A

trapezium squeeze