Palliative and EOL care Flashcards
When does pain become chronic rather than acute?
present for 3 months or more
What is neuropathic pain?
abnormal functioning or damage of the sensory nerves, resulting in pain signals being transmitted to the brain (typically burning, tingling, or loss etc)
What are the three steps to the analgesic ladder?
- non-opioids (paracetamol, NSAIDs)
- weak opioids (codeine, tramadol)
- strong opioids (morphine, oxycodone, fentanyl, buprenorphine)
What are some possible adjuvants for neuropathic pain? (meds)
- amitriptyline (TCA)
- duloxetine (SNRI)
- gabapentin (anticonvulsant)
- pregabalin (anticonvulsant)
- capsaicin cream (topical - made from chillis)
SE of NSAIDs? (5)
- gastritis w/ dyspepsia
- stomach ulcers
-exacerbation of asthma - htn
- renal impairment
SE of opioids? (5)
- constipation
- pruritis
- nausea
- altered mental state
- respiratory depression
What medication reverses the effects of opioids?
naloxone
With opioids, how do you work out the ‘rescue dose’?
rescue dose is 1/6 of the background 24-hr dose
e.g. pt gets 30mg in 24hrs of modified-release morphine, the rescue dose will be 5mg
When might a patient receive subcut pain meds rather than oral?
if they are unable to swallow/SALT assessment or if they have poor GI absorption - remember DOSE WILL CHANGE
What are the 5 symptoms pre-emptives are concerned with?
- pain
- nausea/vomiting
- agitation
- respiratory secretions
- dyspnoea
What pre-emptives are prescribed for nausea/vomiting?
- haloperidol
- metoclopramide
- hyoscine butylbromide
- levomepromazine
What pre-emptives are prescribed for agitation?
- haloperidol
- levopromazine
- midazolam
What pre-emptives are prescribed for secretions?
- hyoscine butylbromide
- glycopyrronium bromide
When prescribing anticipatory meds, what details should be included?
- drug name
- drug dose
- route (usually subcut)
- indication for each med
- frequency of delivery (usually PRN)
- max dose in 24hrs
