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MSRA > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

Palliative care agitation and confusion?

A
  1. 1st line = Haloperidol
  2. 2nd line = Chlorpromazine, levomepromazine
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2
Q

Terminal agitation and restlessness?

A

Midazolam

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3
Q

Starting palliative pain regimen?

A

20-30mg Modifified release morphine + 5mg for breakthrough pain

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4
Q

Breakthrough dose of morphine?

A

1/6th the daily dose

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5
Q

Opioid choice in mild-moderate CKD?

A

Oxycodone

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6
Q

Severe renal impairment painkiller?

A
  1. Alfentanil
  2. Buprenorphine
  3. Fentanyl
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7
Q

Metastatic bone pain Rx?

A
  1. Strong opioids
  2. Bisphosphonates
  3. Fentanyl
  4. Radiotherapy
  5. Denosumab
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8
Q

How much to increase dose of opioids by?

A

30-50%

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9
Q

Transient opioid s/e?

A

Nausea and drowsiness

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10
Q

Persistent opioid s/e?

A

Constipation

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11
Q

Oral codeine to oral morphine?

A

Divide by 10

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12
Q

Oral tramadol to oral morphine?

A

Divide by 10

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13
Q

Oral morphine to oral oxycodone?

A

Divide by 1.5-2

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14
Q

Transdermal 12 mcg fentanyl patch morphine equivalent?

A

30mg oral morphine daily

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15
Q

Transdermal 10mcg buprenorphine patch equivalent?

A

24mg oral morphine daily

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16
Q

Oral morphine to subcutaneous morphine?

A

Divide by 2

17
Q

Oral morphine to subcutaneous diamorphine?

A

Divide by 3

18
Q

Oral oxycodone to subcutaneous diamorphine?

A

Divide by 1.5

19
Q

Palliative hiccups management?

A
  1. Chlorpromazine for intractable hiccups
  2. Haloperidol, gabapentin also used
  3. Dexemethasone particularly used if hepatic lesions
20
Q

6 Palliative care N&V syndromes?

A
  1. Reduced gastric motility = opioid related
  2. Chemically mediated = hypercalcaemia, opioids, chemo
  3. Visceral/serosal = constipation, candidiasis
  4. Raised ICP = cerebral metastases
  5. Vestibular = opioid related
  6. Cortical = anxiety, pain, fear and/or anticipatory nausea
21
Q

Reduced gastric motility nausea and vomiting Rx?

A

Metoclopramide and domperidone (prokinetics)

22
Q

Chemically mediated nausea and vomiting Rx?

A

Ondansetron, haloperidol, levopromazine

23
Q

Visceral/serosal nausea and vomiting causes?

A

Cyclizine and levopromazine

24
Q

Raised ICP N&V Rx?

A

Cyclizine, Dexamethasone, Radiotherapy

25
Q

Vestibular N&V Rx?

A
  1. Cyclizine
  2. Prochlorperizine/metoclopromide
  3. Olanzapine/risperidone in refractory cases
26
Q

Cortical N&V Rx?

A
  1. Lorazepam if anticipatory
  2. If BZDs not ideal, try cyclizine
  3. Can try ondansetron and metoclopramide

MSRA (25 decks)

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