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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
Q

How do we know what dose to use for morphine (oral -> syringe driver)

A

Half the dose

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26
Q

What therapy can be used to control nausea

A

CBT

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27
Q

Name two ways the chemoreceptor trigger zone can be stimulates

A

Drug induced toxicity or metabolic/biochemical upset

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28
Q

What drugs can cause triggering of the chemoreceptor trigger zone

A

Opidoids
NSAIDs
Antibiotics
Antidepressants
Anticonvulsants
Digoxin
Alcohol

Metabolic: Uraemia, Hypercalcaemia, ketoacidosis, Addison’s

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29
Q

First line management of CTZ induced vomiting

A

Metoclopramide 10mg 4 times a day

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30
Q

If metocloopramide is contraindicated, what can be given instead for CTZ vomiting

A

Haloperidol or Levomepromazine

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31
Q

First line management of gastric stasis or partial Gastric Outlet Obstruction/pseudo obstruction

A

Metoclopramide

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32
Q

If the elderly are at a risk of extrapyramidal effects, what drug can be given for gastric stasis

A

Domperidone

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33
Q

If there is extrinsic compression causing gaastric outlet obstruction (partial), what can be given

A

Dexamethasone

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34
Q

side effect of prokinetic agents

A

Oesophageal spasms

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35
Q

First line mamnagemnet of raised ICP vomiting

A

Cyclizine + Dexamethasone

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36
Q

Second line treatment of raised ICP vomiting

A

Levomepromazine SC

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37
Q

Treatment of movement related nausea

A

Cyclizine + Hyosine Hydrobromide

38
Q

Second line treatment of movement related nausea

A

Levomepromazine

39
Q

What can cause oeosphageal vomiting

A

Irritation to vagal and glossopharyngeal nerves (e.g., GORD, Tumours, or inflammation)

40
Q

First line treatment of oesopheageal voimting

A

Cyclizine

Second line: Levopromazine

41
Q

If the cause of vomiting is unknown, what medication should be given

A

Levomepromazine

42
Q

Medication given to nausea associated with anxiety

A

BDZs

43
Q

What is a typical daily starting dose for opioid-naiive patients

A

20-30mg oral morphine

44
Q

How is the dose from codeine to morphine calculated

A

Divide by 10

45
Q

HOw is the dose from oral tramadol to morphine calculated

A

Divide by 5

46
Q

How is the dose from oral morphine to oxycodone calculated

A

Divide by 2

47
Q

How is the dose from oral morphine to oral hydromorphone calculated

A

Divide by 7.5

48
Q

What opioid is less liekly to cause constipation

A

Transdermal fentanuyl

49
Q

How can we treat opioid induced nausea and vomiting in patients

A

Metoclopramide 10mg tds or haloperidol

50
Q

How long are transdermal patches warn

A

72 hours

51
Q

A 12mcg of transdermal fentanyl equates to approximately what dose of morphine

A

45mg

52
Q

If the analgesic effect of transdermal patches is less than 3 days, what should be done

A

Increase the strength not the frequency of switching the patch

53
Q

A transdermal patch of burenoprhine equates to approximately what daily dose of morphine

A

30mg

54
Q

First line management of respiratory secretions

A

Hyoscine Hydrobromide

55
Q

By what percentage do we increase morphine doses if the patient feels their pain is not being well-controlled

A

30-50%

56
Q

HOw can we treat bowel colics

A

Hyoscine Hydrobromide

57
Q

COnversion from oral morphine to diamorphine

A

Divide by 3

58
Q

How to control intractable hiccups at palliative care level

A

Chlorepromazine or Haloperidol

59
Q

How to manage malignant hypercalcaemia

A

3-4L of fluid and THEN bisphosphonates

60
Q

What is febrile neutropenia and when does this happen

A

Where Neutrophil count reaches lowest levels 5-10 days after treatment

Oral temperatre >38.5 degrees + WCC <0.5 x 10^9/ L

61
Q

What causes neutropenic fevers

A

Those recieving chemotherapy (very common)

62
Q

What causes neutropenic fevers

A

Staph Aureus

63
Q

What antibotics should be started in neutropenic fevers

A

Broad spectrum antibiotics (if no identifiable organism can be found)

64
Q

Management of Tumour Lysis Syndrome

A

7 days allopurinol (intermediate risk)

Single dose of Rasburicase (high-risk)

65
Q

What is leukostasis

A

Too high WCC causing ischaemia

66
Q

Management of leukostasis

A

CYtoreduction (with induction chemotherapy)

Or Leukophoresis (if over 100,000 or symptoms)

67
Q

What is the first line managemnet of someone with spinal cord compression from metastases

A

16mg Dexamethasone and THEN radiotherapy

68
Q

What is the first line agent for opiate naive patients

A

Morphine Sulphate (1-2.5mg)

69
Q

Under what cricumstances does Morphine Sulphate not pose as the first line management for pain

A

If eGFR <50

70
Q

If eGFR <50, what is the first line analgesic for patients nearing end of life

A

Oxycodone (1-2 mg SC)

71
Q

What receptors are involved in the chemoreceptor trigger zone

A

D2

5HT3

72
Q

What receptor is involved in Motion Sickness (2)

A

ACh + H1

73
Q

Managment of Superior Vena Cava Obstruction

A

Dexamethasone

74
Q

Managesment of SOPD.Malignancy related sob

A

Morphine

75
Q

Management of Asthma related SOB

A

Salbutamol

76
Q

First line management of breathlessness

A

Opioids

77
Q

What should be given to reduce discomfort associated with painful mouth at end of life

A

Benzydamine Hydrochloride

78
Q

What is the role of octreotide in palliative care

A

Reduce gut secretions + vomit in bowel obstruction

79
Q

Management of respiratory secretions in palliative care

A

Hyoscine or glycopyrronium

80
Q

Management of lymphoedema

A

Complete decongestive therapy (compresion bandaging)

81
Q

Pharmacological management of fatigue

A

Low dose methylphenydate (stimulates CNS)

82
Q

Management of constipation

A

Metoclopramide

83
Q

What type of laxative is senna

A

Stimulant

84
Q

What type of laxative is macrogol (laxido)

A

Osmotic laxative

85
Q

Management of a couggh

A

Morphine

86
Q

What is the first line medication given (specifically) if a patient has an eGFR <30

A

alfentanil SC

87
Q

Management of vomiting caused by pelvic or abdominal tumours

A

Cyclizine

Then Dexamethasone

88
Q

Management of partial bowel obstruction

A

Still use metoclopramide

Stop laxatives

Second line: olanzapine

89
Q

First line management of vomiting from complete bowel obstruction

A

Cyclizine

90
Q

Management of metabolically induced nausea

A

Haloperidol

Year 4 (16 decks)

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