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Palliative Care Flashcards

(52 cards)

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1
Q

Pain ladder

A
  1. simple analgesia
  2. weak opioid
  3. strong opiates
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2
Q

Simple analgesia

A

Paracetamol
NSAIDS
Aspirin

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3
Q

Weak opiates

A

Codeine
Tramadol
Dihydrocodeine

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4
Q

Strong opiates

A

Morphine
Fentanyl patches
Diamorphine
Oxycodone

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5
Q

Bowel obstruction + advanced malignancy

Treatment

A

Palliative colostomy

*NGt initial step for decompression esp if vomiting fecal matter

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6
Q

End stage lung ca + worsening cough +SOB + pleuritic chest pain
Pleural effusion CXR
Treatment>

A

Pleural aspiration - single best management

If extremely ill - not fit for X-ray - consider morphine for SOB

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7
Q

Outpatient on oral morphine - develops side effects

A

Switch to oral oxycodone

Oxycodone - double potency of morphine w/ fewer side effects

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8
Q

Antiemetic for increased intracranial pressure

A

Cyclizine

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9
Q

Medication to help shrink oedema and decrease raised ICP

A

Dexamethasone

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10
Q

Treatment of hypercalcemia secondary to bone mets

A
  1. IV fluids
    +
    IV Bisphosphonates
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11
Q 
Features of hypercalcemia
Neuro
GIT
Renal
CVS
A

Bones stones moans groans

N- lethargy confusion depression
G- constipation nausea vomiting
R - polyuria, polydipsia
C- short QT

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12
Q

Severe bleeding in palliative patient

Management?

A

Midazolam + morphine = subcutaneous

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13
Q

Management of pain due to bone mets

1st & 2nd line

A

1st line- radiotherapy

If fails -
Bisphosphonate + NSAIDS (2nd line)

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14
Q

Management of acute pain due to mets after radiotherapy

A

Morphine sulphate

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15
Q

Management of neuropathic pain

A

Gabapentin
Amitriptyline
Pregabalin
Duloxetine

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16
Q

Management of trigeminal neuralgia

A

Carbamazepine (anticonvulsant)

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17
Q

Gold standard investigation for bone mets

A
  1. MRI*

2. Bone scintigraphy

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18
Q

Sites commonly affected by bone mets

Most common origins

A

SPRSL
Spine >pelvis > rib>skull> long bones

Origins -
Males - prostate, lung
Females - breast,lung

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19
Q

Main dose calculation - oral morphine

A

Sum of all amounts of morphine being received in 24 hrs
__________________________________________________
2

So it can be given 2x a day as a main dose

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20
Q

Oral morphine breakthrough dose calculation

A

Breakthrough dose = additional dose

= 1/6 of total daily dose given PRN 4 hrly
= total main dose / 6

Or

10% of total dose given PRN 4hrly

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21
Q

Terminal patient ask for meds to end life

What do you do?

Study These Flashcards
A

Refer to hospice care

22
Q

What is written in 1a of death certificate?

Study These Flashcards
A

Disease or condition directly leading to death - clear + specific

23
Q

What painkiller should not be given in elderly palliative patients

Study These Flashcards
A

Oral codeine - barely tolerable

**note there is no such thing as SC codeine
It is always oral

24
Q

Side effects of oral codeine develop, what can it be replaced with

Study These Flashcards
A

Buprenorphine patch - optimal
Pick unless the pt is currently in pain as it takes time to work
Or
SC morphine

25
Treatment of capsular pain
NSAIDS - ibuprofen, naproxen
26
``` Anticipatory meds (only given subcutaneously) a-For pain and breathlessness b-nausea and vomiting c-anxiety d-noisy resp secretions ```
A- morphine sc B- haloperidol sc C- midazolam sc D- hyoscine butylbromide sc
27
Treatment of intractable hiccup due to liver ca
Metoclopramide Others - domperidone , nifedipine
28
What causes the hiccup in liver mets
Diaphragmatic irritation = phrenic n irritated = hiccup
29
Treatment of central hiccups
Chlorpromazine
30
Anti emetic in renal failure/hypercalcemia/drug induced vomiting
1.Haloperidol Except in Parkinson’s give 2.levomepromazine (second line)
31
Antiemetic in raised ICP
Cyclizine
32
Antiemetic in delayed gastric emptying
Metoclopramide
33
Antiemetic in chemo/radio
Ondansetron
34
Antiemetic for hyperemesis
1st line - ZINEs cyclizine, promethazine 2 - IV metoclopramide, ondansetron 3- steroids
35
Antiemetic in Ménière’s disease/ BPPV/ Vestibular neuritis
Buccal prochlorperazine
36
How should the prescription of controlled drugs be written
Quantity - Figures + words ** Signature - must be handwritten Age and date of birth of patient - better written, not legally required unless <12yrs ** except oral morphine
37
Step up medication from NSAIDS for gastric ulcers
Tramadol - safe to use
38
Noisy respiratory secretion sin late cancer patient
antimuscarinics Sc hyoscine Others : glycobyrronium bromide sc
39
What delivery method of medication preferred in palliative care
Subcutaneous over IV
40
Morphine vs oxycodone
Oxycodone is double the potency and has fewer side effects
41
Morphine in treatment of cough
Inhibits cough reflex
42
Most appropriate management in pt with cerebral mets - headache + intractable vomiting?
High dose dexa - initial treatment to shrink mass and oedema If GCS = 8 - mannitol (rapid action) Very low GCS + neuro deficit = urgent craniotomy
43
Conversion of oral dose of morphine to subcutaneous
Divide dose by 2
44
Conversion of oral dose of morphine to subcutaneous diamorphine
Divide by 3
45
Conversion of oral dose of tramadol to IV morphine
Divide dose by 20
46
Management of catastrophic bleeding in palliative care
10mg SC midazolam for anxiety | 10mg SC morphine sulphate for pain if required
47
SOB in palliative patients treatment
Oral morphine
48
Palliative patients with bowel obstruction Medication ? Definitive tx? Initial tx?
SC hyoscine butylbromide Def -palliative stoma Initial - NGT
49
Legal prescription requirements (4)
Patient Name + address Age + DOB - if <12 Date Prescriber address If handwritten - FP10 form Handwritten signature
50
Cavitary lesion in pt with lung ca + low grade fever Treatment
Antibiotics
51
PEG vs NGT feed in palliative care
Short term - NGT | Long term - PEG
52
Manage to go leak of PEG after insertion in palliative care
Reassure and continue feed | One off leaks may occur as long as there is no infection

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