Palliative Care Flashcards
Respiratory difficulty RR is 26
but can mobile from chair to bed on herself
what to give / already on palliative care
Anti secretion
Anti breathlessness
Oral Morphine (Usually immobilize patients are given SUBCUTE )
Not
Hyoscine Butyl bromide
Yes subcutaneous morphine should be given for pain and breathlessness but in this stem she is able to mobilize to her chair and back and not bed bound . If they mentioned respiratory secretions or sounds causing breathing difficulty it would be subcutneous hyoscine butylbromide
Terminal lung cancer Pleural effusion
- single best management for pleural effusion»_space;> aspiration - 300-500 ml aspiration - symptoms generally return after few weeks»_space; aspitation again, pleural catheter, chemical pleurodesis
Terminal lung cancer Pleural effusion
- single best management for pleural effusion»_space;> aspiration - 300-500 ml aspiration - symptoms generally return after few weeks»_space; aspitation again, pleural catheter, chemical pleurodesis
Dose caculations
Also,
PO Codeine to PO Morphine –> Divide by 10
PO Tramadol to PO Morphine –> Divide by 10
PO Tramadol to IV Morphine –> Divide by 20
PO Morphine to Subcutaneous Morphine –> Divide by 2
PO Morphine to Subcutaneous Diamorphine –> Divide by 3
PO Morphine to PO Oxycodone –> Divide by 2
PO Oxycodone to SC Oxycodone –> Divide by 2
Anti emitics and
(1) .ODANSTERON.. .. Radio… Chemo..
(2) .CYCLIZINE Raised ICP(Glioblastoma ).. Hyperemesis gravidarum.. Bowel obstruction
(3) .PRO - Kinetic. Agents… Delayed gastric emptying
(4) .(P)ROCHLORPERAZINE — B(PP)V
Glioblastoma - Cyclizine or Dexamethasone
Bone problems
Pain before RT
Pain after RT
> > > Bone Pain dt Metastasis«««<
1st line - «««««»»»»
(If RT failed) 2nd line - Bisphosphonate + NSAIDs
If Pain develops AFTER RADIOTHERAPY - «««<»»»»»>
Bone problems (Prostate cancer pt with severe thigh pain )
Bone pain is not treated INITIALLY WITH morphine
Bone metastasis common pattern - Spine»_space; Pelvic»> Ribs»>Skull» Long bones
> > > Bone Pain dt Metastasis«««<
1st line - «««««»»»»
(If RT failed) 2nd line - Bisphosphonate + NSAIDs
If Pain develops AFTER RADIOTHERAPY - «««<»»»»»>
Bone metastasis INV
Gold standard - MRI followed by Bone scintigraphy
Male - Prostate Cancer
Female - Breast Cancer
Hiccups
Central and Peripheral
Diaphragm and phrenic nerve irritation
Liver metastasis - Metoclopramide / Domperidone / Nifedipine
Central hiccup - Chlorpromazine
Metoclopramide (prokinetics )also in
Anti emetics in Delayed gastric emptying and intestinal obstruction (Peritoneal metastasis)
Terminal patient with Insomnia and anxiety
Lorazepam: Benzodiazepines
Loratadine: Anti histamine anti allergic
Zopiclone : non Benzodiazepines sedative for insomnia (only prescribed for short term)
Insomnia and anxiety - no need to worry for addition so give benzodiazepines
terminal cancer with bowel obstruction for 14 day ( intestinal colic )
vomiting of clear fluids
Abdominal mass
Dont give Senna
Give hyoscine butylbromide (Dries secretion and help with Colic a )
Five cyclizine - Nausea vomiting and bowel obstruction
Prescription Only Medicine (like writing Cheque in bank statement ) and Original signature
above 12 year
……..its ok not to write age below 12 year………
write age
write quantity in words and numbers handwritten signature
Legal requirements for prescriptions of controlled drugs : 1. the quantity of the drug needs to be specified in words and figures eg. 40 (forty) 2. there must be a signature over the printed prescription
Pt who has undergone RT for secondary bone pain
After 1 week still in lots of pain
- He is in sever pain (pain flare dt radiotherapy)
»> the appropriate R is to go up in the pain ladder
»> So morphine sulphate is appropriate. - in the first week after radiotherapy to treat bone metastasis»_space;> it is expected to see sever pain
- Naproxen is similar to ibuprofen (NSAID)
- Buprenorphine patches»_space; takes 12-24hrs to give pain relief and peak at 3 days
- Bisphosphonate is NOT appropriate for acute pain can take up to 6 months for pain benefits
- Hiccup
> > is sudden contraction of the diaphragm (spasm).
- Causes:
- diaphragmatic irritation : dt liver enlargement or gastric distension.
*R: M D N Metoclopramide (((1st line)))) (prokinetic which decrease gastric distension)
Domperidone (prokinetic)
Nifedipine (m. relaxant)
- if M D N are not mentioned»_space;> then choose chlorpromazine
2. Central causes: stroke, head trauma and SOL - R: C then H M P Chlorpromazine (((1st line))) then: Haloperidol Midazolam Phenytoin
- we choose chlorpromazine when. central cause of hiccup .
medications of diaphr. irritations are not options . M D N
medications of diaphr. irritation are alreay tried .
the underlying cause of hiccup is unknown
Halitosis .. Bed breath PA 2270 is With Ca lung Klebsiella
- Halitosis (bad breath)»_space;>oral or not
> > > > 90% dt oral cause»_space;> Antiseptic mouth wash
- in case of lung cavitation»_space; Treatment is Anti Biotics
Halitosis .. Bed breath PA 2270 is With Ca lung Klebsiella
- Halitosis (bad breath)»_space;>oral or not
> > > > 90% dt oral cause»_space;> Antiseptic mouth wash
- in case of lung cavitation»_space; Treatment is Anti Biotics
