Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - GP > GP - Palliative Care > Flashcards

GP - Palliative Care Flashcards

1
Q

When starting palliative management of pain - what analgesics are often used and what formulations?

A

When starting palliative pain treatment in pts with advanced or progressive disease offer (subject to pt preference)

  1. Oral modified-release (MR) morphine
    • OR
  2. Oral immediate-release morphine
    • Also use immediate-release for breakthrough pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the usual starting dose of morphine for pain management in palliative care - for opiod-naïve patients i.e. not previously on opioids?

A

Oral 20-30mg daily in divided doses

e.g. oral immediate-release morphine 4-hourly OR

oral MR morphine 12-hourly

  • Use oral immediate-release for breakthrough pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What other medications may need to be prescribed alongside opiates?

A
  1. Laxatives - for all pts on strong opioids (e.g. senna)
  2. Anti-emetics (Nausea) - advise pts that it is often transient –> if it persists then anti-emetic to cover first several days (e.g. metoclopramide)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A breakthrough dose is a fraction of a pts daily dose of morphine - what fraction?

A

breakthrough dose = between 1/10th and 1/6th of a pts daily dose

e.g. daily 30mg morphine –> breakthrough = 5mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In what condition should opioids be used with caution?

A

CKD - chronic kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which opioids are preferred in a patient with CKD?

A
  1. Fentanyl
  2. Buprenorphine
  3. Alfentanil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Metastatic bone pain may respond to stong opioids, bisphosphonates or radiotherapy.

Which of these had the lowest no. needed to treat for relieving pain?

A

Strong Opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which monoclonal antibody can be used for

management of bone metastases pain?

A

Denosumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are common side-effects of opioids?

A
  • Nausea & vomiting (often transient) - may need anti-emetic
  • Drowsiness (often transient) - may need dose changed
  • Constipation - prescribe laxative e.g. senna
  • Itching / urticaria
  • Sweating
  • Pupil constriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which anti-emetics have prokinetic action?

A

Metoclopramide (D2 antagonist + serotonin receptor antagonist)

Domperidone (D2 receptor antagonist)

  • Prokinetic = medication that helps control acid reflux / encourage gastric emptying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which anti-emetic is often given for nausea / vomiting due to; mechanical bowel obstruction, ↑ ICP and motion sickness?

A

Cyclizine (Histamine H1-receptor anatgonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which anti-emetic if often used for metabolic causes of vomiting e.g. hypercalcaemia, renal failure?

A

Haloperidol (D2 receptor antagonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Conversion Factors:

  1. Oral Codeine / dihydrocodeine –> oral Morphine
  2. Oral Tramadol –> oral Morphine
  3. Oral Oxycodone –> oral Morphine
  4. Oral Morphine –> IV, IM or SC Morphine
  5. IM, IV or SC Diamorphine –> oral Morphine
A
  • Oral Codeine / dihydrocodeine –> oral Morphine (÷ 10)
  • Oral Tramadol –> oral Morphine (÷ 10)
  • Oral Oxycodone –> oral Morphine (x 1.5)
  • Oral Morphine –> IV, IM or SC Morphine (÷ 2)
  • IM, IV or SC Diamorphine –> oral Morphine (x 3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When increasing the dose of morphine for pain management, what % of the daily-dose should the next dose be increased by?

A

30-50% of daily dose every 24 hrs

e.g. 30mg daily-dose –> 45mg daily-dose (24hrs later)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When switching a pt from oral morphine to Buprenorphine or Fentanyl patches you need to reduce the calculated equivalent dose of the new opioid by how much?

A

25-50%

e.g. oral 48 mg morphine = ~ buprenorphine ‘20’ patch

but we use a buprenorphine ‘15’ or ‘10’ patch initially!

Due to risk of opioid induced hyperalgesia (↑ pain sensitivity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How are ‘secretions’ managed in palliative care?

A

Secretions are common in the last days of life - generally more troubling for family than patient

Conservative:

  • Avoid fluid overloading - e.g. stop / reduce IV fluid
  • Educate family that the pt is likely not troubled by secretions

Medical:

  • 1st line = hyoscine butylbromide
  • 2nd line = glycopyrronium bromide
17
Q

What medication can be used to control Anorexia in palliative care?

A

Prednisolone or Dexamethasone

18
Q

How do hyoscine butylbromide and glycopyrronium bromide work?

A

Muscarinic ACh-R antagonists

19
Q

What medication can be used to control Capillary bleeding in palliative care?

A

Oral Tranexamic acid

20
Q

What medication can be used to control constipation in palliative care?

A

Senna tablet or Methylnaltrexone bromide

21
Q

What medication can be used to control Dyspnoea in palliative care?

A

Breathlessness in palliative care can be relieved by

Regular oral morphine (carefully titrated doses)

this suppresses the respiratory drive stimulated by hypoxia and hypercarbia

22
Q

What medication can be used to control Hiccups in palliative care?

A

1st line = Metaclopramide hydrochloride (oral, SC or IM)

2nd line = baclofen, nifedipine or chlorpromazine

23
Q

What medication can be used to control Insomnia in palliative care?

A

Temazepam

(benzodiazepine - enhance effect of GABA at GABAA-receptor)

  • Pts with advanced cancer may not sleep due to discomfort, cramps, night sweats, joint pain etc.
24
Q

What medication can be used to control Muscle spasm in palliative care?

A

Baclofen (GABAB agonist)

OR

Diazepam (benzodiazepine)

25
Q

What medication can be used to control Pururitus in palliative care?

A

Cholestyramine (bile acid sequesterant)

Bile acid accumulation in liver failure or conditions featuring cholestasis

can cause itchy skin

26
Q

What medication can be used to control confusion and restlessness in palliative care?

A
  • Haloperidol - has little sedative effect
  • Levomepromazine - has a sedative effect
  • Midazolam - is a sedative + AED (used in very restless pt)
    • Also used for myoclonus
27
Q

How many copies of a DNAR form are needed for a community patient and who needs to be informed?

A

1 copy remains with patient + 1 copy in patient’s medical records

Inform GP OOH service + ambulance service

28
Q

What steps are involved in the confirmation of death?

A
  1. Wash hands
  2. Confirm identity of the patient (if not known to you)
  3. Inspection for any signs of life - sign of respiration, response to verbal stimuli
  4. Pressure on fingernail or sternal rub to check for any response to pain
  5. Check pupils to ensure fixed and dilated
  6. Feel for carotid pulse for at least 2-5 minutes
  7. Listen for heart sounds for at least 2-5 minutes
  8. Listen for respiratory sounds for at least 3 minutes
  9. Wash hands again and document findings and time of death as you have confirmed it

Year 4 - GP (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions