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Cancer care > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

What percentage of those with advanced cancer experience pain?

A

80-90%

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2
Q

Give 3 examples of opioids for mild-moderate pain

A

Codeine, dihydrocodeine, tramadol

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3
Q

Give 4 examples of strong opioids

A

Morphine, diamorphine, fentanyl, oxycodone

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4
Q

What are some non-opioid adjuvants that can be used in pain management?

A

NSAIDs, bisphosphonates, radiotherapy, corticosteroids

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5
Q

How much more potent is morphine compared to codeine?

A

10 times

Codeine is 1/10th the potency of morphine

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6
Q

What is the maximum dose of codeine phosphate per day?

A

240mg a day (60mg QDS)

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7
Q

How would you convert a maximum daily dose of codeine to morphine?

A

240mg of codeine = 24mg of morphine

Give 30mg of morphine in 24 hours (15mg slow release morphine BD)

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8
Q

When should you avoid tramadol?

A

Epilepsy

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9
Q

What is the equivalent morphine dose of tramadol?

A

Divide dose of tramadol by 10 for equivalent morphine dose

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10
Q

How do you convert to modified released morphine?

A

Calculate total daily dose + PRN and divide into two 12 hour doses of a modified release preparation

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11
Q

How do you work out the PRN dose?

A

1/6th of total daily dose as an immediate release preparation eg oramorph

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12
Q

What are the main side effects of opioids?

A

Constipation
Nausea+Vomiting
Drowsiness
Dry mouth

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13
Q

What are some signs and symptoms of opioid toxicity?

A 
Pinpoint pupils
Sedation
Respiratory depression
Hallucinations
Confusion
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14
Q

Which opioids are safe to give in renal failure?

A

Fentanyl, alfentanil, buprenorphine

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15
Q

What does a 25mcg/h fentanyl patch equate to?

A

25mcg/h fentanyl patch = 60mg/24h oral morphine

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16
Q

How much stronger than morphine is oxycodone?

A

Twice as strong

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17
Q

How much stronger than morphine is diamorphine?

A

Three times as strong

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18
Q

Name an appropriate laxative to be prescribed alongside an opioid

A

Movicol (Macrogol) - osmotic laxative

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19
Q

When should you avoid pregabalin?

A

Decreased renal function

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20
Q

What is an appropriate dose of amitriptyline for the management of neuropathic pain?

A

Amitriptyline 10-25 mg nocte

21
Q

What is an appropriate dose of gabapentin for the management of neuropathic pain?

A

Gabapentin 300mg TDS over 3 days

22
Q

What is an appropriate dose of pregabalin for the management of neuropathic pain?

A

Pregabalin 75mg BD

23
Q

When shouldn’t amitriptyline be used?

A

Ischaemic heart failure, previous MI, previous arrhythmias

24
Q

Give some causes of N+V in palliative care

A 
Pain
Infection
Renal/hepatic impairment
Drugs like chemo or opioids
Hypercalcaemia
Constipation
Bowel obstruction
25
Q

Which antiemetic should be used in chemical causes like Hypercalcaemia?

A

Haloperidol

26
Q

Which antiemetic should be used for gastric stasis?

A

Metoclopramide

Domperidone

27
Q

Which antiemetic should be used in bowel obstruction?

A

Cyclizine

Dexamethasone

28
Q

Which antiemetic should be used for brain mets or raised ICP?

A

Cyclizine

Dexamethasone

29
Q

Which antiemetic should be used in psychological factors?

A

Benzodiazepines

30
Q

Which antiemetic should be used for chemo sickness?

A

Ondansetron

31
Q

Which antiemetic should be used post op or radiotherapy?

A

Ondansetron

32
Q

Which antiemetic should be used in constipation?

A

Metaclopramide

Laxatives

33
Q

How does cyclizine work?

A

Antihistamine (H1 blocker)

34
Q

What are some side effects of cyclizine?

A

Drowsiness, dry mouth, constipation, trouble with vision, urinary retention

35
Q

How does metaclopramide work?

A

Dopamine receptor blocker (D2 receptors in the chemoreceptor trigger zone in the CNS)

36
Q

Name some antiemetics that are dopamine receptor blockers

A

Metaclopramide, domperidone, haloperidol, prochlorperazine

37
Q

How does ondansetron work?

A

Serotonin 5 HT3 receptor antagonist

38
Q

What sort of arrhythmia has ondansetron been associated with?

A

Use of ondansetron has been associated with prolongation of the QT interval, which can lead to a potentially fatal heart rhythm known as torsades de pointes

39
Q

Give some non pharmacological measures to relieve breathlessness

A

Position patient to aid respiration
Air flow over the face - fan or open window
Give oxygen only if hypoxic

40
Q

What is the first line medication for breathlessness at the end of life?

A

Morphine 1-2mg SC PRN

41
Q

What drugs are used in anticipatory prescribing at the end of life?

A 
Morphine 2.5-5mg
Midazolam 2.5-5mg
Haloperidol 2.5-5mg
Glycopyrronium 200mcg
Levomepromazine 6.25-12.5mg
42
Q

What is a WHO performance status of 0?

A

Fully active

43
Q

What is a WHO performance status of 1?

A

Restricted in physically strenuous activity but can do housework etc

44
Q

What is a WHO performance status of 2?

A

Ambulatory and capable of selfceare but not able to carry out work activities

Up and about more than 50% of waking hours

45
Q

What is a WHO performance status of 3?

A

Capable of only limited selfcare

Confined to bed/chair for more than 50% of waking hours

46
Q

What is a WHO performance status of 4?

A

Completely disabled, unable to carry out any selfcare

47
Q

What is a WHO performance status of 5?

A

Dead

48
Q

How is death verified?

A
  • Absence of a carotid pulse over 1 minute
  • Absence of heart sounds over 1 minute
  • Absence of respiratory movements and breath sounds over 1 minute
  • Fixed, dilated pupils not responsive to bright light
  • No response to a trapezius squeeze

Cancer care (3 decks)

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