6. Palliative Care Flashcards
1
Q
What are the essential components of palliative care?
A
- Effective communication
- Team working
- Complex decision making
- Continuity of care
- End of life care
- Bereavement support
2
Q
How is End of Life Care for adults defined?
A
- This includes people who are likely to die within 12 months, people with advanced, progressive, incurable conditions and people with life-threatening acute conditions
- It also covers support for their families and carers
3
Q
What is IMPACT stand for regarding symptom control?
A
I: Identify concerns M: Make an accurate assessment P: Plan your action A: Act C: Continuously re-evaluate T: Talk to other HCP
4
Q
What are approaches to pain management?
A
- Analgesics
- Anaesthetics
- Palliative
- Neurological
- Supportive care
- Inhibition of pain transmission
- Psychotherapeutic apporaches
5
Q
What is a Opioid Rotation?
A
- switch from one opioid to another
- aim is to provide a better balance analgesia and side effects
6
Q
What are the considerations before opioid conversions?
A
- calculate the 24hrly requirements
- convert back to oral morphine
- then convert to alternative opioid
- ensure adequate breakthrough
- consider a dose reduction
7
Q
Describe Fentanyl patches
A
- not any more effective as an analgesic than morphine
- mu receptor agonist
- 50-100x more potent than morphine
- constant drug delivery for 72 hrs
Indication
- stable and chronic pain
- opioid responsive
- When oral route is not available
8
Q
What is Hydromorphone?
A
- analogue of morphine
- 7.5x more potent
- only one major active mtabolite (H3G)
- indicated as an alternative strong opioid in cases of intolerable adverse effects with morphine
- problems at large dose
9
Q
What is Oxycodone?
A
- 1.5-2x more potent than morphine orally
- Available as quick and slow release formulations
- K-opioid receptor agonist
- titratable
10
Q
What is Oxycodone?
A
- mixed pharmacology (NMDA and opioid activity)
- variably long half life and potential for accumulation
- useful when there is a complex element of neuropathic pain
- available as tabs, liquid injection and suppository
11
Q
How do you start methadone?
A
- give morning dose of MR opioid
- continue to use breakthrough doses of opioid for 24 hrs
- 30mg stat methadone 6 hr after morning opioid
- give prn doses methadone 3hrly
12
Q
What are Bone Targeted Agents (BTA) for bone pain?
A
Biphosphonates
- have been shown to reduce the incidence of skeletal complications
- inhibit osteoclast activity
- Consider Strontium Ranelate
: radioactive isotopes - Denosumab
13
Q
How is Antidepressants used in Palliative care europathic pain?
A
- Potentiates inhibitory pathways
- Amitriptyline
: start at 10mg
: usually need at least 50mg - limited by side effects
14
Q
How is Anticonvulsants used in Palliative care europathic pain?
A
- Activates pain suppression pathways
- Sodium Valproate
: 200-1000mg daily
: 4~5 days to steady state
: no clinical trials - Carbamazepine
: common adverse effects
: drug interactions
15
Q
How is Gabapentin used in Palliative care neuropathic pain?
A
- increases GABA synthesis in CNS
- licensed for neuropathic pain
- caution in renal impairment
- Two dosing regimes
: day 1 300mg ON
: day 2 300mg BD
: day 3 300mg TDS
: then up to 600~1200mg TDS
