Palliative Care Flashcards
Define end of life
Those facing imminent death and those with;
- Advance, progressive, incurable conditions,
- General frailty (likely to die within the next 12months),
- At risk of dying from sudden crisis of condition,
- Life threatening conditions caused by sudden catastrophic events
What are the principles of delivering good end of life care
- Open lines of communication,
- Anticipating care needs and encouraging discussion,
- Effective multidisciplinary team input,
- Symptom control,
- Preparing for death,
- Provide support for relative before and after death
What are the possible causes of pain?
- Cancer related,
- Treatment related,
- Associated factors,
- Unrelated to cancer
What are different pain syndromes?
- Bone pain (worse on pressure or stressing bone),
- Nerve pain (burning/shooting/tingling),
- Liver pain (hepatomegaly/URQ tenderness),
- Raised intracranial pressure (headache and/or nausea)
- Colic (intermittent cramping pain)
Explain the WHO analgesic ladder for cancer pain
1) Non-opioid (paracetamol/NSAID) and adjuvant medication
2) Weak opioid (dihydrocodeine or tramadol) whilst continuing simple analgesia +/- adjuvant medication.
3) Strong opioids (diamorphine, fentanyl, oxycodone) whilst continuing simple analgesia +/- adjuvant medication
What are the features of morphine?
1st line strong opioid. Indicated in moderate/severe pain or dyspnoea. It can be administered enterally (oral/rectal), parenterally (IM/SC injections) or via a syringe driver.
Explain how you would start strong opioids
- Stop any weak two opioids.
- Titrate immediate release strong opioids
- Then convert to modified release form and monitor response and side-effects
Describe features of diamorphine
More soluble than morphine so smaller volumes are needed and can be used for parental administration
Describe features of oxycodone
- Second line,
- Fewer hallucinations, less itch, drowsiness or confusions
Describe features of fentanyl patchs
- Second line,
- Lasts 72 hours and can only be used in stable pain.
- Useful if oral/subcutaneous routes are not available.
- Useful is persistent side-effects with morphine
What are the most common side effects of opioids
- Nausea and vomiting,
- Constipation,
- Dry mouth,
- Biliary spasm,
- Opioid toxicity
Explain the management of opioid side effects
Constipation - senna / Bisacodyl and docusate, magrogol (laxido) or co-danthramer alone.
Nausea - Antiemetic such as metoclopramide or haloperidol (consider QT interval)
Describe features of opioid toxicity
- Shadows on the edge of visual field,
- Increase drowsiness,
- Vivid dreams/hallucinations,
- Muscle twitching/myoclonus,
- Confusion,
- Pin point pupils,
- Respiratory depression (rare)
What medication can be used in liver capsule pain/raised ICP?
Steroids such as dexamethasone but remeber to consider gastroprotection
What medications can be used for neuropathic pain?
Amitriptyline, gabapentin or carbamazepine
