Palliative Flashcards

1
Q

What is the initial analgesia used in palliative care?

A

If no comorbidities use 20-30mg of modified release morphine (eg. 15mg BD) with 5mg IR for breakthrough (1/6th daily dose)

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2
Q

How much should you increase opiates by?

A

Increase by 30-50% when uptitrating

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3
Q

How is metastatic bone pain managed?

A
  • Strong opiods
  • Bisphosphonates
  • Radiotherapy
  • Denosumab
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4
Q

What are the conversions from:
a) oral codeine to oral morphine
b) oral tramadol to oral morphine

A

a) divide by 10
b) divide by 10

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5
Q

What are the conversions from:
a) oral morphine to oral oxycodone?
b) oral morphine to SC morphine?
c) oral morphine to SC diamorphine?
d) oral morphine to fentanyl patch?
e) oral morphine to burprenorphine patch?

A

a) divide by 1.5-2
b) divide by 2
c) divide by 3
d) 30mg oral morphine > 12microgram patch
e) 24g oral morphine > 10microgram patch

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6
Q

What is the preferred analgesia in patients with CKD?

A

Alfentanil
Buprenorphine
Fentanyl

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7
Q

What medication should you use for abdominal colic ?

A

Anticholinergics (hyoscine butylbromide)

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8
Q

What medication should be used for intractable hiccups?

A

1st line - chlorpromazine
2nd line - haloperidol, gabapentin
3rd line - dexamethasone (esp if hepatic lesions)

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9
Q

What medication should be used for agitation?

A

First rule out REVERSIBLE causes!

1st line - haloperidol
2nd line - clorpromazine, levomepromazine

In terminal phase of illness, treat with SC midazolam

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10
Q

When is cyclizine used in palliative care?

A

Nausea and vomiting in:
- Intracranial/intravestibular
- Gastrointestinal obstruction
- Movement disorders

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11
Q

When is domperidone used in palliative care?

A

Nausea and vomiting in context of gastric stasis

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12
Q

When is metoclopramide used in palliative care?

A
  • Acute migraine
  • Chemotherapy or radiotherapy induced N&V
  • Gastric stasis (functional bowel obstruction)

Dopamine antagonist

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13
Q

When is ondansetron used in palliative care?

A
  • Chemotherapy induced N&V
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14
Q

When is dexamethasone used in palliative care?

A
  • Nausea related to ICP (add to cyclizine)
  • Anorexia
  • Spinal cord compression
  • Liver capsule pain
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15
Q

When is levomepromazine used in palliative care?

A
  • Chemically mediated N&V
  • Visceral/serosal causes
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16
Q

When are benzodiazepines used in palliative care?

A
  • Nausea related to anxiety
17
Q

What medication is used for bladder spasm?

A

Oxybutynin

18
Q

What medication is used for rectal pain/tenesmus?

A

GTN ointment
Lidocaine ointment
Nifedipine

19
Q

When is haloperidol used in palliative care?

A
  • Agitation
  • Metabolic causes (eg. hypercalcemia, renal failure)
  • Chemical causes of N&V