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Flashcards in Palliative care Deck (28):
1

what are the principles of palliative care

improve qol for patients and their families with a life threatening illness
through prevention and relief of suffering, early identification, impeccable assessment, treatment of pain and other problems

physical, psychosocial and spiritual

2

what does approaching the end of life

likely to die within 12 months

those facing imminent death and those with advanced, progressive, incurable conditions, general frailty
at risk of sudden death
life threatening conditions caused by sudden catastrophic events

3

what are the key themes for development

early identification of patients who may need palliation

advanced anticipatory care planning

care in last hours/days

delivery of effective and timely care

4

what structures have replaced the Liverpool care pathway

One chance to get it right
care for people in the last days and hours of life

5

what are the principles of good end of life care

open lines of communication
anticipation care needs
encouraging discussion
effective MDT input
symptom control
preparing for death
providing support for relatives before and after

6

what is generalist palliative care

part of routine care delivered by all health and social care professionals, at home, in care or in a hospital

7

what is specialist palliative care

can help people with more complex palliative care needs

8

what are some features of pain

can be multifactorial
more than one pain
background/ breakthrough/ incident pain
many causes

9

what are the features of bone pain

worse on pressure/ weight bearing

10

what are the features of liver pain

RIQ tenderness

11

what are the features of raised ICP

headache, worse lying down and in the morning

12

what is colic

intermittent cramping pain

13

what is neuropathic pain

Burning/shooting/tingling/jagging/altered
sensation

14

name some weak opioids

codeine, tramadol, dihydrocodeine

15

name some strong opioids

morphine, diamorphine, fentanyl, oxycodone

16

what does by the clock pain relief mean

analgesics should be given at regular intervals

17

what are some cautions for opioids

renal impairment, acute respiratory depression, elderly

however for terminal illness these should not necessarily rule out use of opioids

18

what are the most common side effects of opioids

nausea, vomiting, constipation, dry mouth, biliary spasm
opioid toxicity

19

what are the features of opioid toxicity

– Shadows edge of visual field
– Increasing drowsiness
– Vivid dreams / hallucinations
– Muscle twitching / myoclonus
– Confusion
– Pin point pupils
– Rarely, respiratory depression

20

what are the features of practical prescribing for morphine

controlled release for background pain relief
twice a day

also breakthrough pain relief as required

21

what must be prescribed for constipation during opioid use

stimulant and softening laxative
senna, bisacodyl, docusate
etc

22

what antiemetics can be prescribed for nausea associated with opioids

metoclopramide
haloperidol (consider QT interval)

23

what can be prescribed for neuropathic pain

Amitriptyline/ Gabapentin/ Carbamazepine

24

what can be prescribed for liver capsule pain/ raised ICP

Steroids (dexamethasone)

25

what can be given for bowel/bladder spasms

buscopan (hyoscine butyl bromide)

26

why are smaller volumes of diamorphine needed

more water soluble than morphine

27

what is oxycodone

second line opioid
less hallucinations, itch, drowsiness, confusion

28

what is fentanyl patch

second line opioid
lasts 72 hours
use in stable pain
use if oral/SC routes unavailable
useful if persistant side effects with first line opioids