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Cancer Care > Palliative Care > Flashcards

Flashcards in Palliative Care Deck (14)
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1
Q

cancer related causes causes of dyspnoea?

A
primary or secondary tumour causing airway obstruction, lung infiltration/lymphangitis carcinomatosis-peri-tumour oedema causing dyspnoea in these cases can be reduced with steroids
pleural effusion/pericardial
ascites
SVC obstruction
phrenic nerve palsy
chest wall pain
fatigue/weakness
immunosuppressed-infection
hypercoagulable state-PE

note also co-exisitng psychological factors e.g. fear, anxiety, distress.

2
Q

how might dyspnoea result from the treatment of Ca?

A

surgery-lobectomy or pneumonectomy
radiotherapy/chemotherapy-pneumonitis, fibrosis, immunosuppression-infection, myelosuppression-anaemia
drugs precipitating fluid retention or bronchospasm

3
Q

how is the morphine dose equivalent of codeine calculated?

A

codeine dose/10

4
Q

when converting someone on codeine to morphine, and codeine dose was inadequate to control pain fully, how much morphine should be given?

A

should be increased by at least 30% from dose equivalent
so if dose equivalent=36mg
then 36+(0.3X36)=46.8, and round up to nearest 10 or 5, so 50mg is new TDD.

5
Q

how much PO morphine prolonged-release should usually be given as starting dose for analgesia in palliative care?

A

if replacing a weaker opioid analgesic then usually 20-30mg modified release morphine BD (every 12 hrs)
with 5mg IR morphine for breakthrough pain

6
Q

preferred opioids in patients with CKD?

A

alfentanil
buprenorphine
fentanyl

7
Q

when is haloperidol a good treatment for N+V in palliative care?

A

when N+V is drug induced or due to a metabolic cause e.g. renal failure, hypercalcaemia, tumour toxins
0.5-1.5mg/12h, max=10mg/24h

levomepromazine good if morphine-induced nausea, but can sedate

8
Q

general non-pharmacological measures that can be used to treat dyspnoea in palliative care?

A
a fan
patient positioning
breathing techniques
energy conservation
PT
distraction
anxiety reduction
visualisation
CBT
goal setting
NIV
9
Q

what treatment can aid a persistent cough in palliative care?

A

sodium chloride nebulisers 5ml as needed

10
Q

treatment via continuous SC infusion for terminal secretions?

A

glycopyrronium 0.6-1.2mg/24h or hyoscine hydrobromide 0.6-2.4mg/24h

11
Q

treatment via continuous SC infusion for bowel colic in end of life?

A

hyoscine butylbromide (buscopan) 20-60mg/24hr

12
Q

treatment via continuous SC infusion for agitation in palliation?

A

midazolam 20-100mg/24h

13
Q

signs of opioid toxicity?**

A
resp depression
coma
pin point pupils
hallucinations
myoclonic jerks
14
Q

commonest side effect when opioids used for cancer pain?

A

constipation

ALWAYS CO-PRESCRIBE A LAXATIVE!