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Geratology and Palliative > Care of the dying > Flashcards

Care of the dying Flashcards

1
Q

Dose reduction in opioid rotation

A

25-50% of calculated dose

Accounts for incomplete cross-tolerance

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2
Q

Calculating breakthrough dose of opioid for breakthrough pain

A

1/6 of 24-hourly dose given orally, PRN

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3
Q

Immediate-release opioid pharmacokinetics

A

Peak concentration within 1-4h

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4
Q

modified-release opioid pharmacokinetics

A

Peak at 2-6h

Sustained for 12-24h

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5
Q

Principles of WHO pain ladder

A

By the mouth

By the clock

By the ladder

For the individual

Attention to detail

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6
Q

Adjuvant drugs for neuropathic pain

A

NMDA receptor blocker (ketamine)

Antidepressant (amitryptilline)

Anticonvulsant

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7
Q

Adjuvant drugs for muscle spasm/cramp

A

Muscle releaxant (e.g. BDZ)

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8
Q

Adjuvant drugs for colic

A

Antispasmodic (e.g. hyoscine)

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9
Q

Adjuvant drugs for bony pain, spinal cord oedema/compression

A

Bisphosphonates

Steroids

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10
Q

GI risk factors for NSAIDs

A

Age >65

Prev peptic ulcer disease

Concurrent meds: warfarin, aspirin, steroids, SSRIs

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11
Q

Dosing for diclofenac

A

75-150mg daily

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12
Q

Dosing for ibuprofen

A

200-400mg tds po

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13
Q

Dosing for naproxen

A

250-500MG BD PO

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14
Q

Opioids for mild-mod pain

A

Codeine

Tramadol

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15
Q

Codeine dosing

A

30-60mg every 4h

Max 240mg per day

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16
Q

Tramadol dosing

A

50-100mg every 4-6h

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17
Q

Drugs accelerating morphine clearance

A

carbamazepine

Phenobarbitol

Phenytoin

Rifampicin

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18
Q

Drugs slowing morphine clearance

A

Renal impairment

Phenothiazines

TCAs

Cimetidine

19
Q

Conversion between morphine and diamorphine

A

Diamorphine is 3x as potent

20
Q

Morphine dosage

A

30-60mg/24h

21
Q

Opioid choice for severe renal impairment

A

fentanyl (liver metabolism) or alfentanil

22
Q

Fentanyl patch frequency

A

Switch every 3 days

23
Q

Time to steady state of transdermal fentanyl

A

72h, do not titrate more frequently

24
Q

Converting from IR ot M/R morphine

A

When patient is stable, calculate total morphine dose

Dive by 2 –> 12-hourly M/R dose

1/6 dose for breakthrough pain

25
Q

Morphine to codeine

A

Multiply by 10

26
Q

Morphine PO to tramadol PO

A

Multiply by 10

27
Q

Codeine/dihydrocodeine/tramadol PO to morphine PO

A

Divide by 10

28
Q

Morphine PO to morphine SC (e.g. for syringe driver)

A

Divide by 2

29
Q

CSCI drugs needing NaCl diluent

A

Diclofenac

Octreotide

Ketamine

30
Q

CSCI drug diluent total

A

21ml

31
Q

Morphine PO > Oxycodone PO

A

Divide by 1.5

32
Q

Oxycodone SC to Oxycodone PO

A

Multiply by 1.5

33
Q

Oxycodone PO to morphine PO

A

Multiply by 1.5

34
Q

Morphine PO to fentanyl TD

A

Morphine (in mg) in 24 hours divided by 3 = fentanyl patch size in mcg/hr

35
Q

Morphine PRN dose

A

2.5-5mg hourly

36
Q

Haloperidol PRN anti-emetic dose

A

0.5-1mg 8-hourly

37
Q

Haloperidol PRN agitation dose

A

1.5-5mg 8-hourly

38
Q

Metoclopromide anti-emetic PRN dose

A

10mg 6-hourly

39
Q

Midazolam PRN dose

A

2.5-5mg hourly

40
Q

Hyoscine PRN dose

A

20mg hourly (max 120 per 24 h)

41
Q

Signs of endo of life

A

PRN ECG

Pupils: non-reactive

Reaction: to stimuli reduced

Neck: Hyperextended

Eyelids: Unable to close fully

Consciousness: Reduced, sleep >50% of day

Grunting: +WOB

42
Q

Management of dry mouth

A

Ice treatment/ice lollies

R/V mouth care every 2h

Regular sips

43
Q

Management of delirium/agitation

A

Consider reversible causes (e.g. retention, constipation)

Haloperidol first-line

Olanzapine 2d line

Midazolam for agitation/restlessness

Geratology and Palliative (5 decks)

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