Palliative Care Flashcards
(18 cards)
What is palliative care?
Managing a patients symptoms, offering emotional, spiritual, psychological and practical support and improving qol
What is end of life?
NICE- palliative care given within last 12 months of life
practice- last days to weeks
what are characteristics of good analgesia?
oral
can be titrated
side effects can be controlled
can be administered when needed at right time
what is the first line strong opioid?
morphine
what is the first line strong opioid in renal impairment?
oxycodone
what is the first line opioid in hepatic impairment?
morphine preferred
what opioid is used in both hepatic and renal impairment?
fentanyl
what is breakthrough analgesia, how much is given and how often?
as required rescue meds. 1/6th of 24 hour dose. given 2-4 hrly PRN (hourly in last days-off label)
what is given for constipation?
stimulant (bisacodyl or sodium picosulfate) and softener (sodium docusate)
what is given in nausea and vom?
levomepromazine- ok in parkinsons
haloperidol
cyclizine (must be diluted with water)- c/i in CHF
what is given for breathlessness?
opioids- due to respiratory depression SE
or benzos
what is given for agitation?
Midazolam 10mg/2ml- 5-10mg 24hrly, 2-5mg breakthrough 2-4hrly
what is given for respiratory secretions?
Gylcopyronium- 600mg in 24hrs, 200mg 2-4hrly breakthrough
what are signs of opioid toxicity and what is the reversal agent?
mycoclonic jerks, confusion, drowsy, PINPOINT PUPILS, resp rate less than 8
Naloxone
what is anticipatory prescribing?
prescribing in advance of symptoms to help reduce delay in managing them
what are benfits of CSCI (syringe driver)?
small
portable
battery
delivers of 24hrs
doses can be adjusted
pre-determined rate
why would someone be started on CSCI?
nbm
too weak for oral
nausea and vom
unconscious
need fine dose adjustments
control multiple symtoms at once
if someone is being switched to a CSCI from MR meds, when should it be started?
8 hours after last oral dose
