Palliative Flashcards
Give 3 signs that someone is in their final weeks of life.
Deteriorating daily or weekly
Confusion
Drowsiness, sleeping more
Eating less (anorexia)
Deteriorating mobility
Increased secretions causing noisy breathing, sometimes called ‘death rattle’
Gut instinct of any team member including family is also important to consider.
Nausea and vomiting is a common problem for patients with advanced cancer. Give 3 anti-emetics and how they work.
Cyclizine - H1-receptor antagonist with direct effects on the vestibular system and chemoreceptor trigger zone. These zones, when activated by, for example, direct pressure from cerebral metastases, can cause nausea and vomiting. Good for intracranial causes.
Domperidone, metoclopramide = Prokinetics. Act on 5HT4, 5HT3 at high doses, to increase gut motility. Used 1st line for nausea resulting from gastric dysmotility and stasis. Ondansetron also acts on 5HT3. Used for treatment of chemically mediated nausea, such as due to opioid medications.
Haloperidol - butyrophenone antipsychotic, D2 antagonist, good for biochemically induced N+V eg opiods, chemotherapy.
Prochlorperazine, levomepromazine - phenothiazine antipsychotics, act on Ach and H1 in higher centres and vestibule, good for multifactorial N+V.
Give 3 ways to help with dyspnoea at end of life.
Treat cause eg bronchodilators for COPD and asthma
dexamethasone/chemo/radiotherapy for superior vena cava obstruction (SVCO)
Diuretics, ACEIs for heart failure
respiratory depressants such as opiods. reduce respiratory drive in response to hypercapnia and hypoxia.
benzodiazepines eg midazolam to reduce anxiety around dyspnoea.
How would you manage a bleed in a dying person?
Mild-moderate - tranexamic acid (not in renal impairment), radiotherapy for lung bleed eg haemoptysis
Major/terminal bleed - stay with the patient. use dark towels. discuss in advance that this may happen, prescribe midazolam 5-10mg IV/IM to reduce awareness and fear so if they do survive they dont remember the experience.
Give 3 drugs that could be used to treat chronic pain at the end of life.
Opiates eg morphine, fentanyl, buprenorphine, oxycodone.
Adjuvants (often used for neuropathic pain):
Anti-epileptics eg carbamazepine, oxcarbazepine
TCAs eg amitriptyline
SSRI eg duloxetine
