Medicine - Palliative Flashcards
What is the most common side effect of cyclophosphamide?
Haemorrhagic cystitis
What are the toxicities of cisplatin?
Ototoxic, nephrotoxic, hypomagnasaemia
Which chemotherapy agent is associated with SIADH?
Cyclophosphamide
What is the starting dose of morphine in palliative care?
15mg morphine MR PO BD
5mg oromorph IR PO PRN
Can start with IR and then when pain controlled –> MR
What is the most common side effect of MR morphine?
Nausea
What opioid is best to use for palliative patients with a GFR of 30-60?
Oxycodone
What opioids are best to use for palliative patients with a GFR of <30?
Fentanyl
Buprenorphine
How much should a breakthrough dose of morphine be?
1/6th of total morphine
100mg codeine is equivalent of how many mg of morphine?
10mg
What is the equivalent of 30mg IR morphine in a MR formulation?
15mg
prescribe half when doing MR
Recall 3 ways in which bony met pain can be managed
- Analgesia
- Bisphosphonates
- Radiotherapy
Which anti-emetic is usually prescribed in palliative care?
Cyclizine
What is the usual dose of cyclizine in palliative care?
50mg 8-hourly
In what patients is it inappropriate to prescribe cyclizine and why?
Cardiac cases
Can worsen fluid retention
Recall 2 patient groups in which metoclopramide should be avoided
Parkinson's disease Young women (risk of dyskinesia)
What is the anti-emetic of choice in Parkinson’s?
Domperidone
What is the drug of choice for agitation in palliative care vs for terminal restlessness?
Agitation in palliative pts: haloperidol (and correct underlying cause)
Terminal restlessness: midazolam
Recall the 1st and 2nd line drugs used for secretions in palliative care
- Hyoscine hydrobromide (anti-muscarinic)
2. Glycopyrronium bromide
What is the first line for treating hiccups in palliative care?
Chlorpromazine
In a patient with cord compression due to spinal mets who is too frail for surgery, what is the treatment of choice?
External beam radiotherapy
What is the anti-emetic of choice for patients with chemo/radio-associated nausea?
Ondansetron + dexamethosone
What is the antiemetic of choice in palliative care for for nausea and vomiting that is due to gastric dysmotility and stasis?
Metoclopramide
What drug is used for painful mouths at end of life care?
Benzydamine hydrochloride
mouthwash / spray
What drug should be prescribed with morphine?
Laxatives
morphine causes constipation
Converting Morphine IV to Sc and diamorphine and oxycodone
divide by 2
divide by 3
divide by 1.5/2
Headache caused by raised intracranial pressure due to brain cancer
Dexamethasone - reduce surrounding oedema
Signs of opiate toxicity
reduced conscious level, slow respiratory rate, myoclonic jerks, and pinpoint pupils
