General palliative care Flashcards
There are two main types of pain fibres in the NS, both synapse with 2˚ neurones in the dorsal horn with considerable plasticity – this is described as the ‘**Gate control’ theory of pain**: - **C fibres** = _________and transmit _____, _______localised and ____-defined sensation - **A-delta** **fibres** = ________and transmit _____, ____ localised sensation
- Unmyelinated
- dull
- poorly
- localised
- ill
- myelinated
- sharp
- well
What is total pain?
Total pain recognizes the holistic nature of pain and the interplay of psychological and social well-being, spirituality, and culture.
What is the gold standard for analgesia in palliative patients?
Morphine sulphate
Which two medications are typically given for nausea and vomiting in anticipatory prescribing?
- Haloperidol
- Levomepromazine
Which two medications are typically given in anticipatory prescribing for agitation?
- Midazolam
- Levomepromazine
Which two medications are typically given in anticipatory prescribing for secretions?
- Hyoscine butyl-bromide
- Glycopyrronium
What is the MOA of metoclopramide? Where does it act? Can it cause side effects?
is a D2 antagonist and 5HT agonist. It acts peripherally as a pro-kinetic and is therefore useful in gut causes of vomiting, but does cross the blood-brain barrier and can therefore lead to unpleasant s/e
What is the MOA of cyclizine. Name two indications for cyclizine.
is a centrally acting D1 receptor antagonist – antimuscarinic and antihistamine. It is useful for vomiting secondary to ICP and in motion sickness.
Which two anti-emetics should never be prescribed together?
Cyclizine and metoclopramide should not be prescribed together as cyclizine slows gastric transit
What is the MOA of haloperidol? Where does it act? What is its indication?
is a D2 antagonist that works at the CTZ, it is therefore useful in biochemical causes of vomiting:
What is the MOA of ondansetron? What should it never be given alongside?
- 5ht antagonist
- NEVER combine with IV metoclopramide
Why should caution be exercised in prescribing levomepromazine?
Levomepromazine lowers seizure threshold
Which anti-emetics are best in gastric stasis?
Prokinetic anti-emetics are best such as Metoclopramide or Domperidone
What is the best antiemetic for gastric irritation (from constipation, bowel obstruction, visceral capsule stretch, or pharyngeal irritation)?
address the cause and prescribe Ondansetron
Name 1 effective anti-emetic for chemical causes of nausea?
Treatment = Metoclopramide, Haloperidol, or Ondansetron
