Misc Flashcards
What are the screening tools for alcohol excess?
CAGE
AUDIT
What are some clinical signs of chronic alcoholism?
Hands: Palmer erythema, Dupuytren’s contracture
Abdo: gynaecomastia, testicular atrophy, splenomegaly
Skin: spider naevi
Neuro: liver flap, polyneuropathy, sensory ataxia, cerebellar signs, confusion/Wernicke’s encephalopathy, Korsakoff’s syndrome (anterograde and retrograde amnesia, confabulation)
What is the weekly max alcohol intake recommendation?
14 units a week over 3 or more days with some alcohol-free days
What is Wernicke’s encephalopathy?
acute thiamine (vit B1) deficiency
Triad:
🔺ophthalmoplegia
🔺fluctuant mental state
🔺ataxia
What are some medical managements of alcohol excess?
Benzos - chlordiazepoxide regime for withdrawal
Disulfram promotes abstinence C/I in IHD and psychosis
Acamprosate reduces cravings
What is the Karnofsky Performance Status Scale?
The Karnofsky Performance Status Scale is an assessment tool used to assess patients’ prognosis and likelihood of survival. The ranking runs from 100 to 0, where 100 is “perfect” health and 0 is death.
What is the Phases of illness tool in palliative tool?
The phases of illness tool assesses the care needs of the patient and their family and whether a suitable care plan is in place. Patients are split into five categories: stable, unstable, deteriorating, dying and deceased. Patients can move between categories in any direction, a change in category indicates a need for re-assessment.
What are some signs a patient might be approaching the end of their life?
- Sleeping more than 50% of the day
- Feeling tired when they are awake
- Eating and drinking less, losing their appetite
- Getting out of bed less or not at all
- Finding that small activities use up the majority of their energy
What are the 4 main classes of anticipatory medication for palliative care?
- Analgesia: for pain
- Anti-emetic: for nausea and vomiting
- Anxiolytic: for agitation
- Anti-secretory: for respiratory secretions
Give examples of pain management in palliative care?
Common first-line agent for opiate naïve patients:
- Morphine sulphate 1 – 2.5mg SC. Do not repeat within 1-hour, maximum 4 doses in 24 hours
- If reduced renal function (eGFR <50): Oxycodone 1 – 2 mg SC. Do not repeat within 1-hour, maximum 4 doses in 24 hours
For patients already on a background dose of opioid medication, the PRN anticipatory dose is generally 1/6th of the total subcutaneous background dose in 24 hours.
What is an example of anticipatory medicine for nausea and vomiting in palliative care?
Haloperidol 0.5 – 1.5mg SC. Do not repeat within 4 hours, maximum dose 3mg in 24 hours.
What is an example of anticipatory medicine for agitation in palliative care?
Midazolam 2.5 – 5mg SC. Do not repeat within 1 hour, maximum 4 doses in 24 hours.
What is an example of anticipatory medicine for secretions in palliative care?
Hyoscine butylbromide 20mg SC. Do not repeat within 1-hour, maximum dose 120mg in 24 hours
