Topic 5: palliative care Flashcards
(45 cards)
What is palliative care?
- active total care of patients whos disease is not responsive to curative treatment
- it doesn’t hasten or postpone death, but allows those involved in the care of patients to relieve pain and other symptoms in an environment of the patients choice.
Who is part of providing palliative care?
- patient
- family and friends
- GPs
- pharmacists
- oncology district nurses
- hospice nurses
- hospice doctors
- others as needed
What is the pharmacists’ role in palliative care?
- liaise with all prescribers, nurses and other treatment providers to ensure that medications match symptoms
- liaise with patients and family and friends to ensure their concerns are taken into account
- advise GPs as to dose conversions from oral to parenteral
- managing total medication needs
What are we trying to alleviate in palliative care?
- pain
- alimentary symptoms
- respiratory symptoms
- psychological symptoms
- biochemical symptoms
How is pain managed?
-by moving along the WHO pain ladder as pain needs increase or cease to be well controlled by existing medications
What can NSAIDs and paracetamol mask and therefore require care?
these can suppress temperatures and mask signs of infection
What are the types of pain?
nocioceptor - deep or aching
neuropathic - burning, shooting or stabbing pain
How is pain assessed?
- be aware that not all pain is due to cancer
- rule out pain due to pre-existing conditions such as osteoarthritis
- ask what makes the pain worse or better
How is pain diagnosed?
- asking about symptoms
- knowing the causes of pain
What are simple analgesics?
step 1 of the WHO ladder:
Paracetamol or NSAIDs
What is step 2 of the analgesic ladder?
paracetamol or NSAIDs PLUS weak opiods
e.g. paracetamol + codine or ibuprofen + codeine
What is step 3 of the analgesic ladder?
REGULAR paracetamol or NSAIDS plus strong opiod
e.g. paracetamol + morphine
Paracetamol + methadone
paracetamol + oxycodone
What happens if pain decreases?
you should go back down the ladder because pain prevents the central depressant effects of opiods
What are examples of co-analgesics or adjuvant analgesics?
corticosteroids like dexamethasone
antidepressants & anti-epileptics like amitriptyline and valproate
antipasmodics like buscopan (hyocsine N-butyl bromide
Muscle relaxants like diazepam
What types of analgesics treat organ or soft tissue pain?
- paracetamol + codine
- oral morphine
- parenteral morphine
What types of analgaesics treat bone pain?
NSAIDs and morphine
What types of analgesics treat nerve pain?
- valproate
- carbamazepine
- gabapentin
- ketamine
What sort of analgesics treat headache from intracranial pressure?
dexamethasone
What type of analgesics treat pain from GI obstruction?
Hyoscine N-butylbromide (buscopan)
How is incident or breakthrough pain managed?
- give rapid onset opioid such as morphine elixir
- aim of treatment is to give appropriate analgesia to control chronic pain and treat break through pain with rapid acting opioids
What are the causes of nausea?
chemoreceptor trigger zone stimulation
vomiting centre stimulation
vagal stimulation
vestibular stimulation
What are the causes of pain?
constipation GI blockage tumour growth unresolved issues about death and dying incident pain
How is CTZ induced vomiting treated?
1st line: haloperidol
2nd line: levomepromazine
How is vomiting centre induced nausea treated?
1st line: cyclizine
2nd line: dexamethasone
