Palliative and EoL Care Flashcards
(25 cards)
Palliative Care
- Definition
Palliative Care definition
- Active total care
i) Pain
ii) Symptoms
iii) Social
iv) Psychological
v) Spiritual - Disease not responsive to curative treatment
EoL Care
- Definition
EoL Care Definition
- Approaching the end of life
- Likely to die within 12 months
- “would you be surprised if…”
Clinical frailty
- 9 Scores
Clinical frailty
1-2
Very fit - Well
3-4
Managing well - Vulnerable
5-6
Mildly frail - Moderately frail
7-9
Severely frail - Very severely frail - Terminally ill
CFS
- Mildly frail
Mildly Frail
- Evident slowing
- High order IADLs
- Impaired
- Shopping
- Walking alone
- Meal prep and housework
CFS
- Moderately frail
Moderately frail CFS
- All outside activities require help
- Help with keeping house
- Stairs and bathing
CFS
- Severely frail
CFS Severely Frail
- Completely dependent for personal care
- Physical
- Cognitive - Even if stable
CFS
- Very severely frail
Very severely frail CFS
- Completely dependent
- Approaching EoL
- Could not recover from minor illness
CFS
- Terminally ill
Terminally ill CFS
- Approaching EoL
- Life expectancy <6 months
- Not otherwise evidently frail
signs of a dying patient
- cheyne-stokes respiratory pattern
- respiratory secretions - causes rattling breathing
- pallor
- temperature changes at extremities
- decreased level of consciousness
- agitation/restlessness
- decreased/absent oral intake
anticipatory drugs
- morphine 2.5-5mg
- levomepromazine 2.5-5mg
- midazolam 2.5mg
- glycopyrronium bromide 200mcg
all in syringe driver
what are the symptoms of EoL that need managing
- pain
- dyspnoea
- NV
- agitation
- respiratory tract secretions
2 types of pain
nociceptive - normal nervous system, identifiable lesion
- somatic, visceral
neuropathic - malfunctioning nervous system
- from surgery, radiotherapy etc
- won’t respond to opioids
name common non-opioids
- paracetamol
- NSAIDs
- COX2
what are adjuvants in pain relief and name a few
not it’s primary indication
- gabapentin/pregabalin
- amitriptyline
- benzodiazepines
- bisphosphonates
name some opioid medications
- codeine
- morphine (1st line)
-oxycodone (mild/moderate renal imp) - fentalyl, alfentanil, buprenorphine (severe renal imp)
- tramadol
describe WHO pain lader
- non-opioid + adjuvants
- weak opioids + non-opioid + adjuvant
- strong opioids + non-opioid + adjuvant
side effects of opioids
initial, ongoing and rare
initially:
- NV, cognitive clouding, drowsiness, light-headed
common on-going:
-dry mouth
- constipation
rare:
- respiratory depression - more likely in AKI
- psychological dependence
titrating codeine to morphine
codeine:morphine is 10:1
240mg is highest dose of codeine
so 24mg morphine equivalent
starting dose needs to be higher
prescribing morphine
- background and PRN
SR -> slow release (background dose)
- BD
IR -> immediate release (PRN)
- 1/6 total daily
converting oral to SC morphine
oral:SC is 2:1
half prescription as it’s twice as potent
principles of fentanyl patches
- takes 12-24 hours to achieve steady state
- only come in certain doses
- use oromorph as PRN (1/6 of 24 hour morphine equivalent
- always use a chart to convert (provided)
opioid toxicity
Sx
- pinpoint pupils
- hallucinations
- drowsiness
- vomiting
- confusion
- myoclonic jerks
- respiratory depression
causes of opioid toxicity
- commonest problem - error in prescribing
- AKI - common cause → send renal bloods immediately
- nerve block and forget to reduce pain relief
- dose escalated too quickly?
- pain not opioid responsive but opioids increased?
what is included on a contolled drug prescription
name, form, strength, total in words and figures
