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Flashcards in Palliative Care Deck (31)
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1

What does palliative care focus on?

QoL of patients and their families
Prevention and relief of suffering
Physical/psychosocial/spiritual problems

2

What proportion of patients die during their admission to hospital?

1/10

3

Name 5 symptoms that need to be controlled in end of life care

Fatigue
Pruritis
Dyspnoea
Pain
Muscle cramps

4

What affects pain?

Physical
Psychological (fear, anxiety, anger)
Social (carer strain, fear)
Spiritual (anguish, suffering, hopelessness)

5

What is the WHO pain ladder?

The steps taken as pain worsens
Start with non opioid +/- adjuvants (paracetamol, NSAIDs)
Progress to mild opioid +/- non opioid +/- adjuvant
Then to strong opioid

6

What does PRN mean?

As needed (pro re nata)

7

Dosing of opioids

Regular doses of immediate release opioid + PRN 1/6 of total

8

SE of opioids?

Nausea, vomiting, constipation, sweat, itch

9

6 signs of opioid toxicity

Myoclonic jerks
Agitation
Visual hallucinations
Confusion
Pin point pupils
Respiratory depression (late)

10

How do you deal with opioid toxicity?

Due to problems in renal excretion/liver metabolism?
Switch to different opioid?
Opioid antagonist (naloxone)
Fentanyl patches

11

What opioid is best for renal insufficiency?

Oxycodone

12

What is the most common life threatening metabolic disorder encountered in patients with cancer?

Hypercalcaemia

13

8 signs/symptoms of hypercalcaemia

Nausea and vomiting
Anorexia
Constipation
Feeling thirsty
Polyuria
Drowsy, confused
Coma
Cardiac arrythmias
Abnormal neurology

14

How do you manage hypercalcaemia?

Rehydration
Bisphosphonate infusion (pamidronate)
(Takes 3-5days)

15

What pattern of nausea and vomiting does someone experience in bowel obstruction?

Little nausea, large volume vomit, better after vomit

16

What pattern of nausea and vomiting does someone experience in drug induced n&v

Constant nausea, little vomit, no relief after vomit

17

What causes nausea?

Taste, candida, secretions
Bowel stasis, gastritis, constipation, obstruction
Drugs
Hypercalcaemia/uraemia
Infection
Increased ICP
Motion sickness
Fear, smell association

18

What receptors does the vomiting centre have?

H1 (Histamine)
Muscarinic
5HT2 (serotonin)

19

What receptors does the inner ear have?

Histamine
Muscarinic

20

What receptors does the CTZ have?

D2 (dopamine)
5HT3 (serotonin)
NK1 (neurokinin)

21

What receptors does the gut have?

5HT3 (serotonin)
CB1 (cannabinoid)
NK1 (neurokinin)

22

What commonly causes bowel obstruction in palliative patients

Extrinsic compression
Omental masses
Post irradiation fibrosis
1º tumour in bowel
Infiltration into mesentery/muscle -> peristalsis affected

23

Signs and symptoms of complete bowel obstruction

Colicy pain
Distended abdomen
No bowel action for a while
No flatus
Large volume faecalent vomits

24

Palliative treatment for bowel obstruction

Pain control
Anti emetics
Anticholinergics (decrease secretions)
Somatostatin analogues (decrease secretions)
Laxatives (improve gut motility)
NG tube as last resort]Stents/bypass surgery can be of benefit
Venting gastrostomy

25

Name 3 antiemetics

Cyclizine
Levomapromazine
Metochlopramide

26

Name 2 antipasmodics

Hysocine butybromide
Octreotide

27

5 symptoms of spinal cord compression

Back pain
Parasthesia
Muscle weakness
Incontinence
Sensory changes

28

What level does spinal cord compression become cauda equina syndrome?

L1/L2

29

Treatment of spinal cord compression?

High does steroid, radiotherapy+/- surgery

30

What causes neuropathic pain

Pressure/destruction of peripheral, autonomic or central nervous system