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Year 4 > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

How often can Metoclopramide be given

A

3-4 times a day

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2
Q

Side-Effect of metoo=lopramide

A

Can induce acute dystonia

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3
Q

In what people are dystonic reactions from metoclopramide more common in

A

Young girls and women and people taking drugs that can cause extrapyramidal side effects (e..g, Parkinson’s)

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4
Q

How to treat an acute dystonic reaction from metoclopramide

A

Procyclidine

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5
Q

More common side effects of metoclopramide

A

Drowsiness and restlessness

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6
Q

How can dompierdione beb given

A

Orally or Rectally

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7
Q

COmplication of domperidone

A

Ventricular arrythmias

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8
Q

At what dose are the risk of cardiac arrests greatest in people with domperidone

A

Over 30 mg

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9
Q

How does Hyoscine work

A

Blocks Acetylcholine

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10
Q

WHen is Hyosine indictaed for nausea

A

Ear problems + Motion sickness

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11
Q

How does cyclizine and promethazine function

A

Block H1 receptors

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12
Q

What drug blocks the chemoreceptor trigger zone

A

DOmperidone

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13
Q

How does metoclopramide work and what is it indicated in

A

GI issues, works directly in the gut

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14
Q

When is Aprepitant indictaed

A

Chemotehrapy induced nausea

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15
Q

How does Aprepitant work

A

Neurokinin-1 recpetor antagonist

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16
Q

What is Step 1 in the analgesic ladder

A

NSAIDs + Paracetamol

NON OPIOIDS

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17
Q

What is Step 2 in the analgesic aldder

A

Weak Opioids:

  • Codeine
  • Co-Codamol (usually given after step 1)
  • Tramadol
  • Dihydrocodeine
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18
Q

What is Step 3 in the analgesic ladder

A

Strong opioids (oxycodone, Morpphine, Fentanyl etc)

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19
Q

What should all opioids be prescribed with

A

Laxatives (senna)

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20
Q

What is the conversion of the dose of codeine to morphine

A

Just divide dose by 10

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21
Q

Under what eGFR can morphine not be given

A

eGFR < 30

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22
Q

What painkillers are typically given if your eGFR < 30

A

Fentanyl
Alfentanyl
Buprenorphine

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23
Q

How do we calculate a PRN dose of painkillers

A

1/6th the dose

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24
Q

Adjuvants for bony metastatic pain

A

Radiotherapy + Bisphosphonates

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25
How do we know what dose to use for morphine (oral -> syringe driver)
Half the dose
26
What therapy can be used to control nausea
CBT
27
Name two ways the chemoreceptor trigger zone can be stimulates
Drug induced toxicity or metabolic/biochemical upset
28
What drugs can cause triggering of the chemoreceptor trigger zone
Opidoids NSAIDs Antibiotics Antidepressants Anticonvulsants Digoxin Alcohol Metabolic: Uraemia, Hypercalcaemia, ketoacidosis, Addison's
29
First line management of CTZ induced vomiting
Metoclopramide 10mg 4 times a day
30
If metocloopramide is contraindicated, what can be given instead for CTZ vomiting
Haloperidol or Levomepromazine
31
First line management of gastric stasis or partial Gastric Outlet Obstruction/pseudo obstruction
Metoclopramide
32
If the elderly are at a risk of extrapyramidal effects, what drug can be given for gastric stasis
Domperidone
33
If there is extrinsic compression causing gaastric outlet obstruction (partial), what can be given
Dexamethasone
34
side effect of prokinetic agents
Oesophageal spasms
35
First line mamnagemnet of raised ICP vomiting
Cyclizine + Dexamethasone
36
Second line treatment of raised ICP vomiting
Levomepromazine SC
37
Treatment of movement related nausea
Cyclizine + Hyosine Hydrobromide
38
Second line treatment of movement related nausea
Levomepromazine
39
What can cause oeosphageal vomiting
Irritation to vagal and glossopharyngeal nerves (e.g., GORD, Tumours, or inflammation)
40
First line treatment of oesopheageal voimting
Cyclizine Second line: Levopromazine
41
If the cause of vomiting is unknown, what medication should be given
Levomepromazine
42
Medication given to nausea associated with anxiety
BDZs
43
What is a typical daily starting dose for opioid-naiive patients
20-30mg oral morphine
44
How is the dose from codeine to morphine calculated
Divide by 10
45
HOw is the dose from oral tramadol to morphine calculated
Divide by 5
46
How is the dose from oral morphine to oxycodone calculated
Divide by 2
47
How is the dose from oral morphine to oral hydromorphone calculated
Divide by 7.5
48
What opioid is less liekly to cause constipation
Transdermal fentanuyl
49
How can we treat opioid induced nausea and vomiting in patients
Metoclopramide 10mg tds or haloperidol
50
How long are transdermal patches warn
72 hours
51
A 12mcg of transdermal fentanyl equates to approximately what dose of morphine
45mg
52
If the analgesic effect of transdermal patches is less than 3 days, what should be done
Increase the strength not the frequency of switching the patch
53
A transdermal patch of burenoprhine equates to approximately what daily dose of morphine
30mg
54
First line management of respiratory secretions
Hyoscine Hydrobromide
55
By what percentage do we increase morphine doses if the patient feels their pain is not being well-controlled
30-50%
56
HOw can we treat bowel colics
Hyoscine Hydrobromide
57
COnversion from oral morphine to diamorphine
Divide by 3
58
How to control intractable hiccups at palliative care level
Chlorepromazine or Haloperidol
59
How to manage malignant hypercalcaemia
3-4L of fluid and THEN bisphosphonates
60
What is febrile neutropenia and when does this happen
Where Neutrophil count reaches lowest levels 5-10 days after treatment Oral temperatre >38.5 degrees + WCC <0.5 x 10^9/ L
61
What causes neutropenic fevers
Those recieving chemotherapy (very common)
62
What causes neutropenic fevers
Staph Aureus
63
What antibotics should be started in neutropenic fevers
Broad spectrum antibiotics (if no identifiable organism can be found)
64
Management of Tumour Lysis Syndrome
7 days allopurinol (intermediate risk) Single dose of Rasburicase (high-risk)
65
What is leukostasis
Too high WCC causing ischaemia
66
Management of leukostasis
CYtoreduction (with induction chemotherapy) Or Leukophoresis (if over 100,000 or symptoms)
67
What is the first line managemnet of someone with spinal cord compression from metastases
16mg Dexamethasone and THEN radiotherapy
68
What is the first line agent for opiate naive patients
Morphine Sulphate (1-2.5mg)
69
Under what cricumstances does Morphine Sulphate not pose as the first line management for pain
If eGFR <50
70
If eGFR <50, what is the first line analgesic for patients nearing end of life
Oxycodone (1-2 mg SC)
71
What receptors are involved in the chemoreceptor trigger zone
D2 5HT3
72
What receptor is involved in Motion Sickness (2)
ACh + H1
73
Managment of Superior Vena Cava Obstruction
Dexamethasone
74
Managesment of SOPD.Malignancy related sob
Morphine
75
Management of Asthma related SOB
Salbutamol
76
First line management of breathlessness
Opioids
77
What should be given to reduce discomfort associated with painful mouth at end of life
Benzydamine Hydrochloride
78
What is the role of octreotide in palliative care
Reduce gut secretions + vomit in bowel obstruction
79
Management of respiratory secretions in palliative care
Hyoscine or glycopyrronium
80
Management of lymphoedema
Complete decongestive therapy (compresion bandaging)
81
Pharmacological management of fatigue
Low dose methylphenydate (stimulates CNS)
82
Management of constipation
Metoclopramide
83
What type of laxative is senna
Stimulant
84
What type of laxative is macrogol (laxido)
Osmotic laxative
85
Management of a couggh
Morphine
86
What is the first line medication given (specifically) if a patient has an eGFR <30
alfentanil SC
87
Management of vomiting caused by pelvic or abdominal tumours
Cyclizine Then Dexamethasone
88
Management of partial bowel obstruction
Still use metoclopramide Stop laxatives Second line: olanzapine
89
First line management of vomiting from complete bowel obstruction
Cyclizine
90
Management of metabolically induced nausea
Haloperidol

Year 4 (16 decks)

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