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Year 4 CCC > Palliative care > Flashcards

Palliative care Flashcards

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1
Q

Examples of immediate release morphine
Onset of these?
How long do they last?

A

Oramoprh soln or sevredol tablets

onset 20 mins last 4 hours

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2
Q

Examples of Slow release morphine
Onset of these?
How long do they last?

A

MST or Zomorph capsules
4 hours
last 12 hours

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3
Q

How do you work out the Opioid PRN dose from the total background dose?

A

PRN dose is 1/6th of the total 24 background dose

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4
Q

What do you write on the Opioid PRN dose ‘Max’ section?

A

6x/day

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5
Q

How do you increase the background opioid dose?

A

Increase by 30-50%

THEN RECALCULATE PRN DOSE

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6
Q

What opioids are preferred in the context of renal failure?

A

Oxycodone, Fentanyl/Bupre patches

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7
Q

What drugs are usually prescribed with opioids?

A

A laxative like Senna

Anti-emetic like haloperidol or cyclizine

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8
Q

How long do Fentanyl patches last?

A

Up to 72 hours

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9
Q

How long do buprenorphine patches last?

A

5/10/20 MCG last 7 days

35/52.5/70 MCG last 96 hours

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10
Q

Indications for opioid patches?

A

Stable pain, renal failure, cannot take oral medication

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11
Q

Signs of opioid Overdosing?

A 
Confusion
Drowsiness
Myoclonic jerks
Hallucinations 
Pinpoint pupils
RR<10
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12
Q

Conversion rate for oral morphine to:

1) SC morphine
2) SC Diamorphine

A

1) oral to SC morphine then DIVIDE BY 2

2) Oral morphine to SC Diamorphine then DIVIDE BY 3

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13
Q

Immediate release oxycodone name?

Slow release oxycodone name?

A

Immediate release oxycodone name- Oxynorm

Slow release oxycodone name- Oxycotin

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14
Q

Indications for a syringe driver?

Does this indicate EoL?

A 
Cannot swallow
LoC/Dec Consciousness
Persistent N&amp;V
Intestinal obstruction
Malabsorption of drugs

Important to explain that this does not indicate EoL!

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15
Q

Analgesic ladder

A

1- Non-opioids
2- Weak opioids like Co-codamol 30/500
3- Strong opioids

+/- Adjuvants like NSAIDS/Amitryptiline, Gabapentin, AD, Corticosteroids

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16
Q

Good treatments for bone pain

A

NSAIDS +/- RT/Bisphosphonates

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17
Q

Good treatment for bowel obstruction pain

A

Hyoscine butylbromide + Analgesic ladder

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18
Q

Treating headache due to raised ICP

A

Corticosteroids + NSAIDS/Paracetamol

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19
Q

Neuropathic pain treatment

A

Amitryptiline or Gabapentin

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20
Q

Symptoms of N&V due to gastric stasis/irritation?

Treatment?

A

Sudden sickness, relief upon vomiting, heart burn

Metoclopramide B/C pro-kinetic

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21
Q

Causes of gastric stasis/irritation?

A

Stomach cancer, liver mets, Ascites, Dexamethasone, NSAIDS, Aspirin

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22
Q

Symptoms of N&V due to toxicity?

Treatment?

A

Constant sickness, vomiting does not provide relief, retching

Haloperidol or cyclizine
Can then try levomepromazine

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23
Q

Causes of Toxicity related N&V

Study These Flashcards
A 
Renal failure
Chemotherapy
RT
Opiates
Digoxin
Hypercalcaemia 
Electrolyte problems 
Infection
Liver failure
24
Q

Treating chemotherapy related N&V

Study These Flashcards
A

Metoclopramide if post-med

Ondansetron +/- Dex if PRE-MED

25
Symptoms of N&V due to cerebral irriation? | Treatment?
Early morning headache, vomiting, severe nausea, neuro symptoms Dex or cyclizine
26
Causes of N&V due to cerebral irriation?
Brain mets, Inc ICP, Sights/smells, anxiety before chemo, RT to brain
27
How do you treat anxiety related nausea before chemotherapy?
Lorazepam
28
Which anti-emetic is broad spectrum?
Levomepromazine
29
``` Anti-emetics... 5-HT3 antagonism? Antipsychotic? H1 antagonsim D2 antagonist? Various receptors? ```
5-HT3 antagonism- Ondanestron Antipsychotic- Halperidol H1 antagonsim- Cyclizine D2 antagonist- Metoclopramide (Pro-kinetic) Various receptorsLevomepromazine broad spec
30
Examples of Softening osmotic laxatives
Lactulose | Docusate
31
Examples of stimulating laxatives When do you avoid these
Senna Bisacodyl During colic
32
Softener and stimulating laxatives When to use
Movicol Co-danthrusate Co-danthramer (Carcinogenic) Infrquent, hard stools
33
Symptoms of intestinal obstruction
``` Post-prandial N&V Colicky pain Dull ache Distension Relief on vomiting ```
34
Managing intestinal obstruction symptoms
Levomepromazine Hyoscine butylbromide Opioid Stop stimulants like Senn/Dantron
35
What sign would indicate a patient likely has constipation and not obstruction
Presence of flatus
36
What factors are considered for surgical intervention in intestinal obstruction ?
``` Performance status Disease status Co-morbidities Symptoms Level of obs ```
37
best imaging modality for Intestinal obstruction
CT
38
How can you relieve dyspnoea
Lorazepam PO OR,,, Midazolam and morphine sulphate SC +/- Fan in face, relaxation, treat reversibility
39
Signs that someone is approaching end of life
``` Profound weakness Confined to bed Disorientation Severely limited attention span To weak to swallow Losing interest in eating/drinkin ```
40
Examples of medications that can be stopped in EoL
``` Vitamins Horomes Statins Abx Anticoag CS CV drugs AD ```
41
Examples of medications that should be continued in EoL
``` Analgesia Antiemetics Antisecretories Anxiolytics Insulin Anticonvulsants ```
42
How do you treat terminal restlessness in EoL care
Check: Pain, Bladder, Bowels, Secretions, Family (May be reversible) Midazolam SC up to 5mg
43
What is a 'death rattle' | How do you treat it?
Secretory movement in upper airways Non-painful Reposition Hyoscine butylbromide
44
Criteria for a screening tool for cancer
Able to detect early enough by simple tests to be cured Sensitive and specific tests Well tolerated test (E.G Bronchoscopy is not) Easy, inexpensive, well publicised
45
Current screening for... Cervical cancer Breast CRC
Cervical- 25-64 smear every 3 years till 49 then every 5 years Breast- 50-70 Women, Mammography every 3 years CRC 60-74, Colonoscopies if at risk
46
Indications for DNACPR
Approaching end stage of terminal disease Worsening frailty and multi-morbidity Long term condition with life threatening exacerbations Lots of unplanned hospital admissions CPR wont work, pt doesnt want it or not in their best interests
47
Different co-codamol dosages
8/500 16/500 30/500 2X TAB 4X A DAY
48
What route can codeine not be given via
IV
49
What are the 4 anticipatory meds of palliative care
Analgesia Anti-emetic Hyoscine butylbromide Agitation meds (Haloperidol/Benzo)
50
What are the 2 steps to confirming death?
1) Check mechanical cardiac function= NO PULSE AND NO HEART SOUNDS (5 mins) 2) Absence of pupillary light reflex, corneal reflexes and motor response to supra-orbital pressure TIME OF DEATH IS WHEN BOTH ARE FULFILLED
51
What are sections 1a and 2a for on the death certificate
``` 1a= Immediate direct cause of death (1b/c are events that lead to this) 2a= Significant other co-morbidities that contributed ``` If you put organ failure you must put what it was secondary to! NO ABBREVIATIONS/SYMBOLS
52
Indications for coroner referral
``` Mesothelioma Violence, trauma, injury Toxic substance exposure Self-harm/Neglect Employment related Unknown cause Unknown identity No attending practitioner 14 days prior to death/not available within a reasonable time of death ```
53
Who fills out the death certificate?
A Dr who attended the patient during their last illness within last 14 days Must do it within 24 hours of being informed Examine if crematorium planned
54
If patient is agitated but not terminal then what drug is 1st line
Haloperidol
55
Symptoms of terminal agitation? What causative agents should be checked?
Restlessness, vocalisations, Emotional fluctuations Remember to check: Pain, Bladder, Bowels, Family and compliance
56
When to suspect delirium in agitation?
``` Sepsis Multi-organ failure Cannot focus Confusion Hallucinations Disorientation ```
57
Treating agitation vs treating delirium
If agitated then consider midazolam If delirious then make non-pharmacological changes (Routine, family involvement, same nursing staff, low lighting) and possibly consider adding haloperidol

Year 4 CCC (3 decks)

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