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Palliative care > Palliative > Flashcards

Palliative Flashcards

1
Q

What is supportive care?

A

care for patients who are potentially curative, but could die

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2
Q

What are the 3 categories for causes of nausea and vomiting?

A

bowels, brain, biochemical

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3
Q

Name 3 antiemtics

A

haloperidol, cyclizine, ondansetron, domperidone

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4
Q

What are 5 things that may indicate that someone is starting to die?

A 
respiratory effort is laboured or shallow 
consiousness levels fluctating more
decreased mobility 
social withdrawal 
struggling to take meds 
worsening performance 
Cardio - pulse strength weaker, mottled skin 
Resp - noisy due to secretions 
Vital sign changes 
weight loss and poor appetite
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5
Q

Which key things do you need to help with when someone is dying?

A

pain
secretions
medication review
reverse causes of agitation e.g. constipation

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6
Q

What are the 5 priorities of care for dying?

A

communication
dying person and their loved ones are involved
people important to patient are listened to and respected
care is tailored to individual and delivered with compassion
possibility of person dying shortly is recognised and clearly communicated

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7
Q

Which 5 things do pre-emptive medications need to be provided for and give examples?

A 
pain - morphine 
breathlessness - morphine 
resp secretions - buscopam/ glycopyrronium
N&V - haloperidol 
distress/agitation - midazolam
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8
Q

What are 3 palliative care emergencies?

A 
neutropenic sepsis 
spinal cord compression
Superior vena cava compression 
stridor
opioid overdose 
malignant hypercalcaemia 
massive haemorrhage
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9
Q

What are signs of malignant hypercalcaemia?

A

bone pain, confusion, constipation, depression, abdominal pain

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10
Q

How would you treat malignant hypercalcaemia?

A

IV fluids and bisphosphonates, denosumab

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11
Q

How would you treat an opioid overdose in a palliative case?

A

nalaxone - dilute in 10ml N saline - 20mcg every 2 minutes

- 400mcg stat if life threatening

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12
Q

How would you treat spinal cord compression?

A

dexamethasone

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13
Q

What are some signs of superior vena cava compression and how would you treat it?

A

facial swelling, oedema, arm swelling, breathlessness

dexamethasone, anticoagulation, stenting, radiotherapy

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14
Q

What are two opioids that can be given by transdermal patch?

A

fentanyl or buprenorphine

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15
Q

What is an unlicensed medicine?

A

medicine without European or UK marketing authorisation for use in humans

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16
Q

What is an off-licence/off-lable medicine?

A

a licensed medicine used for unlicensed application

- up to 1/4 of palliative prescriptions

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17
Q

What are some mechanisms of vomiting?

A 
biochemical upset (e.g. drugs)
anxiety
raised intracranial pressure 
motion sickness 
GI tract - gastric stasis, intestinal obstruction, gastric irriation
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18
Q

What are some non-pharmacological managements of nausea?

A

control odours - e.g. colostomy
minimise sight/smell of food
give small snacks not large meals
acupressure wrist bands

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19
Q

What are some drugs to manage nausea and vomiting?

A

haloperidol (chemical causes)
metoclopramide, domperidone (GI or chemo)
levomepromazide (non-specific)
cyclizine (motion sickness, raised ICP)
granisetron (chemo, radio, post-op)
hyoscine (smooth muscle spasm, secretions)

20
Q

What are some cough suppressants (antitussives)?

A

codeine, morphine, methadone

21
Q

What are some demulcents (antitussives)?

A

soothing agents e.g. glycerol syrup

22
Q

What are some expectorants (protussives)?

A

encourage more productive cough

- sodium chloride neb 0.9% 5mL PRN

23
Q

How would you treat surface bleeding?

A

tranexamic acid 1g Po tds-qds

low dose radiotherapy

24
Q

What is the analgesic ladder?

A

non-opiod e.g. paracetamol, NSAIDs
weak opioid - codeine phosphate
strong opioid - morphine

25
Q

What are some examples of adjuvant analgesics?

A

amitriptyline, carbamazepine, gabapentin, pregabalin, clonazepam, duloxetine, oxcarbazepine, corticosteroids, bisphosphonates, baclofen, antidepressants

26
Q

How would you initiate strong opioids?

A

four hourly prn
regular 4 hourly
and assess pain after 24 hours
if pain free add up total given over 24 hours and convert into twice daily sustained/modified release

27
Q

What are the two types of breakthrough/episodic pain?

A

predictable/incident

unpredictable/unexpected

28
Q

What are some SE of morphine?

A 
N&V
constipation 
congnitive impairment
respiratory depression 
urinary retention 
hallucinations 
dry mouth 
sweating 
pruritus
29
Q

What are some alternatives to morphine?

A 
oxycodone 
fentanyl 
buprenorphine 
alfentanil 
methadone 
ketamine
30
Q

What should be consulted when switching between types of medication?

A

opioid conversion chart

31
Q

What are the indications for a syringe driver?

A

patient unable to take oral meds
poor absorption of oral meds
intestinal obstruction

32
Q

What is preferred injection route?

A

subcut
IM - painful, hard in wasted patients
IV - hazardous, hard to get access

33
Q

What is an acronym to support care in the last hours or days of life?

A

ADD CARING
Assessment
Discussions
Documentation

Confirm who is responsible for care 
Attitudes, awareness, environment 
Review plan 
Identify additional people who need to be involved
Nutrition and hydration 
Goals - confirm and document changes
34
Q

Which anti-emetic would you give in gastric stasis?

A

metoclopramide

10mg x3/daily orally

35
Q

What anti-emetic would you give for PD and gastric stasis and why?

A

domperidone - doesn’t cross blood-brain barrier as metoclopramide does

36
Q

What would you give to reduce anxiety?

A

benzos - lorazepam, medazolam

37
Q

What can you use topically to stop bleeding?

A

tranexamic acid

adrenaline

38
Q

How do you convert immediate to modified release morphine?

A

Add up total and half

39
Q

If patient was sleepy/hallucinating on morphine what would you switch to?

A

oxycodone

  • methadone as last line
40
Q

If the dosage conversion of morphine to fentanyl is in the middle what should you do?

A

Go down a patch

- tolerance and different receptors hit

41
Q

How long should you continue morphine after fentanyl patch added?

A

continue morphine for 12 hours

42
Q

What should be prescribed alongside syringe driver?

A

What the drug needs to be mixed with
- water
occaionally saline

43
Q

What adult weight should you be careful when prescribing paracetamol?

A

50kg

44
Q

Which pain killers are better for neuropathic pain?

A

amitriptyline
gabapentin
pregabalin

45
Q

What are some SE of amytriptyline?

A

constipation, dry mouth

46
Q

Which painkiller is quite last resort?

A

methadone

47
Q

What is involved in emergency bleed plan?

A

dark sheets and towels ready
stay with patient and support them - DO NOT LEAVE
midazolam IM

Palliative care (2 decks)

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