9) Pallative Care Flashcards
What is the primary focus of palliative care?
The primary focus of palliative care is improving the quality of life through symptom management, and providing emotional, psychological, spiritual, and social support.
What does ‘total pain’ refer to?
Total pain refers to the combination of physical, psychological, spiritual, and social suffering experienced by patients, especially those in the last days of life.
What is the first-line opioid used in palliative care for severe pain?
Morphine is the first-line strong opioid for severe pain in palliative care.
What is a syringe pump used for?
A syringe pump is used to administer medications continuously at a pre-determined rate, typically over 24 hours, when oral medication is not feasible.
What opioid is preferred in patients with renal impairment?
Oxycodone is preferred in patients with renal impairment.
What medication is commonly used for managing nausea in palliative care?
Cyclizine is commonly used for managing nausea and vomiting in palliative care.
How is breakthrough pain typically treated in palliative care?
Breakthrough pain is treated with a PRN (as-needed) opioid dose, usually 1/10th to 1/6th of the 24-hour dose.
What is the WHO Analgesic Ladder?
The WHO Analgesic Ladder is a stepwise approach to managing pain, starting with non-opioids and progressing to strong opioids as pain severity increases.
- Non-opioid +/- adjuvants
- Weak-opioid + non-opioid +/- adjuvants
- Strong- opioid + non-opioid +/- adjuvants
What is a common symptom of opioid toxicity?
Common symptoms of opioid toxicity include myoclonic jerks, confusion, hallucinations, and drowsiness.
What opioid is preferred for a patient with hepatic impairment?
- Hepatic impairment (Without concomitant renal impairment)
Morphine is preferred - Severe renal and/or hepatic impairment, or dialysis patients Seek specialist advice.
- Alfentanil, fentanyl or buprenorphine may be
preferred.
What is the role of Levomepromazine in palliative care?
Levomepromazine is a broad-spectrum antiemetic and antipsychotic used to manage nausea, vomiting, and agitation in the last days of life.
How do you manage opioid-induced nausea in palliative care?
Opioid-induced nausea can be managed with antiemetics such as cyclizine, which does not exacerbate symptoms of Parkinson’s disease.
What factors should be considered when choosing opioids for palliative care?
Factors include the patient’s renal and hepatic function, the severity of pain, and the presence of other symptoms such as nausea.
In which cases is fentanyl a suitable opioid for palliative care?
Fentanyl is suitable for chronic pain management, especially when a patient cannot tolerate oral medications or has swallowing difficulties.
What is the role of Glycopyrronium in managing symptoms in the last days of life?
Glycopyrronium is an anti-secretory drug used to manage excess respiratory secretions in patients nearing the end of life.
How would you transition a patient from oral morphine to a syringe pump?
To transition from oral morphine to a syringe pump, calculate the total 24-hour oral morphine dose (including regular and breakthrough doses), then convert to a subcutaneous dose using a 2:1 conversion ratio (oral:SC). For example, 60 mg oral morphine in 24 hours = 30 mg SC morphine over 24 hours via syringe pump. Prescribe breakthrough SC doses at 1/6th of the 24-hour SC dose.
What is the role of Midazolam in palliative care?
Midazolam is used to manage agitation, anxiety, and seizures in palliative care, often via subcutaneous infusion.
What is the difference between morphine sulfate and MST in palliative care?
Morphine sulfate is an immediate-release form of morphine, while MST (Morphine Sulfate Tablets) is a controlled-release form for managing chronic pain.
How would you manage opioid-induced constipation in palliative care?
Opioid-induced constipation can be managed with a combination of stimulant laxatives like senna and stool softeners like sodium docusate.
What is the purpose of anticipatory prescribing in palliative care?
Anticipatory prescribing ensures that medications are available in advance to manage symptoms that are likely to arise in the last days of life, such as pain, nausea, or agitation.
How would you adjust opioid therapy for a patient with renal impairment?
For renal impairment, opioids with minimal renal metabolism, such as oxycodone or fentanyl, should be used. The dose should be reduced by 25-50%.
What is the main cause of nausea in cancer patients?
Nausea in cancer patients is often caused by tumor toxins, chemotherapy, or bowel obstruction, and is treated with antiemetics like cyclizine or metoclopramide.
What is the main role of Metoclopramide in palliative care?
Metoclopramide is used to manage nausea and vomiting, especially in cancer patients or those with opioid-induced nausea.
What should be considered when prescribing opioids in patients with liver disease?
Patients with liver disease may have altered drug metabolism, so opioids like oxycodone and hydromorphone, which are metabolized differently, are preferred.
