Pallative Flashcards

1
Q

Palliative care prescribing: agitation and confusion

A

correct underling issue
1st line. Haloperidol
2nd. Chlorpromazine, levopromazine

terminal ilness- midazolam

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2
Q

Hiccups

A

1st line- chlorpomazine

if hepatic lesions use dexamethasone

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3
Q

6 causes of N+V

A

Reduced Gastric Motility
CHemically Mediated- hypercalcaemia, opioids
Visceral/serosal- constipation
Raised ICP- cerebral metastases
Vestibular- motion related or skull tumours
Cortical- anxiety and pain, fever

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4
Q

managment of N+V

A

reduced gastric motility- metoclopramide

Chemically mediated - Ondanestron, haloperiodol, levopromazine

Visceral/serosal- cyclizine/ levopromazine

Raised ICP- cyclizine, dexamethasdone

Vestibular- cyclizine

Coritcal- benzo- lorazepam

If the oral route is not possible the parenteral route of administration is preferred

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5
Q

When starting patients on pain releif what medications should we give?

Notable SX

A

oral modified-release (MR) or oral immediate-release morphine (depending on patient preference. eg- 20-30mg of MR a day with 5mg morphine

laxatives should be prescribed for all patients initiating strong opioids
patients should be advised that nausea is often transient. If it persists then an antiemetic should be offered
drowsiness is usually transient - if it does not settle then adjustment of the dose should be considered

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6
Q

breakthrough dose of morphine

In renal impairment what medication

metastatic bone pain

A

1/6th total daily dose

oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred

metastatic bone pain respond to strong opioids, bisphosphonates or radiotherapy

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7
Q

if pain not controlled by an opioid how much should we increase by?

A

30-50%

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8
Q

Oral codeine to oral morphine

Oral tramadol to oral morphine

A

both divide by 10

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9
Q

oral morphine to oral oxycodone

A

divide by 1.5/2

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10
Q

Transdermal preparations

A

a transdermal fentanyl 12 microgram patch equates to approximately 30 mg oral morphine daily
a transdermal buprenorphine 10 microgram patch equates to approximately 24 mg oral morphine daily.

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11
Q

oral to subcut prep

A

Oral morphine Subcutaneous morphine Divide by 2
Oral morphine Subcutaneous diamorphine Divide by 3
Oral oxycodone Subcutaneous diamorphine Divide by 1.5

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11
Q

oral to subcut prep

A

Oral morphine Subcutaneous morphine Divide by 2
Oral morphine Subcutaneous diamorphine Divide by 3
Oral oxycodone Subcutaneous diamorphine Divide by 1.5

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12
Q

Secretions management

A

Avoiding fluid overload - particularly stopping IV or subcutaneous fluids
Educating the family that the patient is likely not troubled by secretions

hyoscine hydrobromide or hyoscine butylbromide is generally used first-line

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13
Q

painful mouth lesions management

A

benzydamine hydrochloride

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