General Flashcards
What are the four domains of palliative medicine?
Physical, psychological, social, spiritual
What are the four types of pain?
Physical, social, psychological, spiritual
How can physical pain be categorised?
Nociceptive, somatic, visceral, neuropathic
Name examples of non-opioid analgesics
ibuprofein, NSAIDs, paracetemol, aspirin
Examples of weak opioids?
Codeine, tramadol, low-dose morphine
Examples of strong opioids?
Morphine, fentanyl, oxycodone, hydromorphone
Examples of adjuvants for analgesic therapy?
antidepressants, anticonvulsants, biphsophaonate, corticosteroid
Can you combine opioid drugs within the same class?
no
What is OME/MEDD?
oral morphine equivalent= morphine equivalent daily dose
What are the four components of the 4AT test?
Alertness (0-4)
AMT4 (Abbreviated mental test= DoB, date, location- 1 mistake=1, >2 mistakes= 2),
Attention (months of the year backwards- max score of 2),
Acute change/fluctuating course (0 or 4)
Name three factors that can precipitate opioid toxicity
Drug interactions, renal impairment, sepsis, rapid dose escalation
Name three symptoms of opioid toxicity
Hyperalgesia, sedation, delerium, hallucinations, myoclonus, vivid dreams/nightmares
Name four symptoms that anticipatory medicine aims to address?
Pain, nausea & vomiting, agitation, SoB, respiratory secretions
How much more potent is injection morphine relative to oral morphine?
Twice as potent
How would you calculate the PRN subcut dose of morphine relative to the daily dose?
PRN dose= 1/6th to 1/10th of total daily dose
The total daily dose of injection morphine is 60 mg. What would be an appropriate PRN dosage?
Between 6mg and 10mg (1/6th-1/10th)
Which tools/scores can be used to measure the physical decline of a patient? e.g.from cancer
Clinity frailty scale= Rockford frailty score (1-9), palliative care indicator scoring
List three triggers for nausea and vomiting
- Gut (chemical/stretch) 2. Vestibular-cochlear (motion) 3. Chemotactic trigger zone (chemical disturbances in blood) 4. Limbic system (emotion/stress/pain)
What are the signs/symptoms of bowel obstruction?
vomiting, nausea, abdo pain
How to distinguish between upper and lower GI obstruction?
upper- more vomiting and nausea
Lower- more significant pain
How to estimate prognosis for unwell patient?
Rate of change and physical mobility. E.g. if one month ago they were mowing the lawn and are now bed ridden and don’t know where they are, this would be a matter of weeks at most
Which antiemetic drug is used in chemotherapy but not in surgery/palliative care
ondansetron
Should you mostly calculate 1/6 or 1/10 of morphine for breakthrough doses?
1/6, 1/10 might be too low of dose, best to apply this to patients who may be more frail/sensitive
