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Y4 Respiratory > Intro to Palliative care > Flashcards

Intro to Palliative care Flashcards

1
Q

Define what pallative care is

A

•Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual

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2
Q

What is included in palliative care ?

A
  • Active total care of patinets whose disease is not responsive to curative treatment
  • Symptom control, whilst attending to patient & families needs
  • Planning for the future
  • End of life care
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3
Q

When should palliative care begin ?

A

Palliative & EOL care can only be delievered if health care professionals recognise individual patients needs & that patient might be in the last year of their life

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4
Q

What do people want at the end of their life ?

A
  • To be with loved ones
  • To avoid life prolonging treatments & interventions
  • To puttheir affairs in order
  • To have good symptom control
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5
Q

What should all doctors do to achieve a good palliative approach ?

A
  • Provide a patient & family centred approach - not disease centred
  • Listen & be empathetic
  • Treatments to reverse what is reversible
  • Reocgnise when a patient is reaching the last months of their life
  • Have courageous conversations
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6
Q

List some of the common physical symptoms experienced by patients with incurable diseases

A
  • Pain
  • N&V
  • Fatigue
  • Anorexia/ poor appetite
  • SOB/Dyspnoea
  • Itch
  • Drowsiness
  • Constipation/diarrhoea
  • Psychological symptoms
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7
Q

How is pain assessment usually carried out ?

A

Using a simple verbal rating scale:

  • 0 = no pain at rest, none on movement
  • 1 = no pain at rest, slight on movement
  • 2 = intermittent at rest, moderate on movement
  • 3 = continuous at rest, severe on movement
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8
Q

What is the step 1 of pain management ?

A

For mild intensity pain:

  • 1st line = Paracetamol or an NSAID
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9
Q

What is step 2 for the management of pain ?

A

For mild-moderate intensity pain:

  • 1st line = weak opiod (codeine or dihydrocodeine) + paracetamol or NSAID
  • Prescribe a laxative (senna or macrogol) and consider anti-emetic (metoclopramide or haloperidol)
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10
Q

What is step 3 of pain management ?

A

For moderate-severe intensity pain:

  • 1st line = strong opiod (morphine or diamorphine) + paracetamol or NSAID
  • Consider prescribing a laxative and anti-emetic.
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11
Q

What should be prescribed with an NSAID ?

A

A PPI

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12
Q

What are the signs of opiod toxicity ?

A
  • persistent sedation (exclude other causes)
  • vivid dreams, hallucinations, shadows at the edge of visual field
  • delirium
  • muscle twitching/myoclonus/jerking
  • abnormal skin sensitivity to touch.
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13
Q

What is the management of opiod toxicity ?

A
  • Give oxygen
  • Adjust dose or stop delivery of opioid until situation satisfactory
  • If necessary give naloxone
  • Titrate to effect
  • Respiratory depression may be delayed after intrathecal or epidural opioids.
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14
Q

If paracetamol or NSAIDs are unsuitable for someone what painkiller may be used ?

A

Nefopam - it is a non-opioid, non-NSAID analgesic occasionally preferred where alternatives are contraindicated or ineffective

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15
Q

WHO pain ladder

A
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16
Q

There are two key issues when prescribing in renal impairment:

  1. Further damage to renal function
  2. Accumulation of active metabolites

Therefore what 2 things should be done ?

A
  1. Best to avoid NSAIDS
  2. Some drugs have minimal active metabolites e.g paracetamol or fentanyl so wont accumulate - Most other analgesics can be used but dosage needs to be reduced to allow for decreased clearance.
17
Q

If a patient is vomiting there PO route is no good, what 2 other drug routes should not then be forgotten about ?

A

Sl & pr routes

18
Q

PO morphine dose needs to be how many times higher than IV/IM morphine ?

A

2-3 times higher

19
Q

What are the 1st line options for treating neuropathic pain ?

A

1st line = amitriptyline or gabapentin (occasionally pregabalin is used 1st line but seek specialist help)

20
Q

What is the palliative care management of SVC obstruction/stridor ?

A
  • Refer urgently to the appropriate specialist for consideration of, for example, stenting or radiotherapy.
  • In the meantime give high-dose corticosteroids either dexamethasone or prednisolone
21
Q

What is the palliative care management of SOB ?

A

Optimise O2 therapy

  • 1st line = opiods
  • 2nd line = corticosteroids
  • 3rd line = benzodiazapines
22
Q

What is the general management of itch?

A
  • Treat the underlying cause
  • Use an emollient
  • Consider using a sedating antihistamine such as hydroxyzine at night
23
Q

What is the general management of N&V?

A
  • Correct the correctable (for example renal function, hypercalcaemia, hyponatraemia, hyperglycaemia, constipation, symptomatic ascites, cerebral oedema/raised intracranial pressure, review medicines).
  • Consider non-pharmacological measures (refer to non-pharmacological management below).
  • Choose an anti-emetic appropriate to a likely identified cause.
  • A combination of anti-emetics may be appropriate.
  • A broad spectrum anti-emetic may be indicated if multiple concurrent factors are present.
  • Adjuvant corticosteroid and/or benzodiazepine may be combined with the prescribed anti-emetic drug(s).
  • Try to avoid the concurrent prescribing of prokinetics (for example QTmetoclopramide) and anticholinergics (for example cyclizine) medication. The anticholinergics will diminish the prokinetic effect.
24
Q

What are the main examples of anti-emetics (drugs used to treat N&V)?

A
  • Antihistamines e.g. Cyclizine
  • 5HT3 antagonists e.g. Ondansetron
  • Antidopaminergic e.g. Prochlorperazine, Metoclopramide
  • Anticholinergic e.g. Hyoscine
25
Q

What is the management of fatigue/weakness ?

A
  • Dietary advice
  • Energy conservation/restoration e.g. deligate tasks, pace your activites etc
  • Appropriate level of physical exercise/activity recommended
  • Psychosocial advice e.g. sleep pattern advice
26
Q

What is the management of anorexia/poor appetite ?

A

Offer information and practical advice about nutrition, diet and managing anorexia. Encourage patients and their carers to focus on enjoying food

Explain that a gradual reduction in oral intake is a natural part of the illness.

Medication options:

  1. Corticosteroids provide a short-term improvement in appetite
  2. Progestogens (Megestrol acetate) May stimulate appetite and weight gain in patients with cancer.
  3. Prokinetics (metoclopramide or doperidome) Used for early satiety, delayed gastric emptying, gastroparesis or nausea.
27
Q

What is the palliative management of constipation ?

A
  • 1st line = stimulant +/-softener (senna or bisacodyl)
  • 2nd line = Osmotic laxative (Macrogol (for example Laxido®))
28
Q

What is the palliative care management of diarrhoea ?

A

Rehydrate as necessary preferably by the oral route + specific treatment

29
Q

What is the 1st line treatment of depression in palliative care ?

A

SSRI - sertraline

30
Q

What is the 1st and 2nd line treatment of delirium?

A
  • 1st line = haloperidol
  • 2nd line = benzodiazepines (lorazepam or midazolam)
31
Q

What just incase medicines should be prescribed for someone in end of life care?

A

Y4 Respiratory (27 decks)

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