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General practice > Palliative care > Flashcards

Palliative care Flashcards

1
Q

Causes of reduced gastric motility linked vomiting and nausea in palliative care

A

May be opioid related

Related to serotonin(5HT4) and dopamine(D2) receptors

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2
Q

Causes of chemically mediated nausea and vomiting

A

Hypercalcaemia
Opioids
Chemotherapy

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3
Q

Visceral/serosal causes of nausea and vomiting

A

Constipation

Oral candidiasis

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4
Q

Vestibular causes of nausea and vomiting

A

Related to activation of acetylcholine and histamine (H1) receptors

Most frequently in palliative care is opioid related

Can be motion related, or due to base of skull tumours

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5
Q

Cortical causes of nausea and vomiting

A

May be due to anxiety, pain, fear and/or anticipatory nausea

Related to GABA and histamine (H1) receptors in the cerebral cortex

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6
Q

management of chemically mediated nausea and vomiting

A

Ondansetron

Haloperidol

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7
Q

Mx of visceral/serosal nausea and vomiting

A

Cyclizine and levomepromazine

Anti-cholinergics such as hyoscine may be useful

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8
Q

Mx of raised ICP linked nausea and vomiting

A

Cyclizine

Dexamethasone

Radiotherapy if cranial tumours

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9
Q

Management of anticipatory nausea

A

Lorazepam

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10
Q

When are oral anti-emetics not suitable

A

Vomiting
Malabsorption
Severe gastric stasis

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11
Q

What should be co-prescribed with opioids for pain relief

A

Laxatives

Nausea if often transient but antiemetic can be offered

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12
Q

Breakthrough dose of morphine

A

1/6th daily dose of morphine

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13
Q

Preferred opioid in mild-to-moderate renal impairment

A

Oxycodone

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14
Q

Preferred pain relief in severe renal impairment

A

alfentanil, buprenorphine and fentanyl are preferred

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15
Q

Mx of metastatic bone pain

A

strong opioids, bisphosphonates or radiotherapy

Referral to oncology

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16
Q

Mx of hiccups

A

Chlorpromazine in intractable hiccups

Halperidol, gabapentin also used

Dexamethasone if hepatic lesions

17
Q

First line mx of agitation and confusion

A

Haloperidol

other options - chlorpromazine

18
Q

Management of excessive secretions in terminal stage of life

A

Hyoscine hydrobromide

Glyopyrronium bromide may also be used

19
Q

When should syringe drivers be considered

A

hen a patient is unable to take oral medication due to nausea, dysphagia, intestinal obstruction, weakness or coma

20
Q

Definition of neutropenic sepsis

A

defined as a neutrophil count of < 0.5 * 10^9 in a patient who is having anticancer treatment and has one of the following:

a temperature higher than 38ºC or
other signs or symptoms consistent with clinically significant sepsis

21
Q

Prophylaxis in neutropenic sepsis

A

if it is anticipated that patients are likely to have a neutrophil count of < 0.5 * 109 as a consequence of their treatment they should be offered a fluoroquinolone

22
Q

Mx of neutropenic sepsis

A

Tazocin immediately

May be a role for G-CSF in selected patients

23
Q

Four main classes of meds for anticipatory end of life prescribing

A

Analgesia: for pain
Anti-emetic: for nausea and vomiting
Anxiolytic: for agitation
Anti-secretory: for respiratory secretions

24
Q

Conversion of oral morphine sulphate to fentanyl patch

A

25 mcg/hr fentanyl patch = 60mg oral morphine

25
Q

Morphine oral to subcut conversion

A

Half to convert to SC

26
Q

Causes of nausea in a patient with advanced lung cancer

A 
Constipation 
Chest infection 
Liver mets 
Brain mets 
Hypercalcaemia
27
Q

Treatment of nausea and vomiting due to raised ICP

A

Dexamethasone, cyclizine

28
Q

Mx of nausea and vomiting in renal failure

A

Haloperidol

29
Q

Mx of nausea and vomiting in opioid induced nausea

A

Metoclopromide, domperidone and haloperidol

30
Q

Non-drug measures for management of dyspnoea

A

Fan, air circulation, open windows
Positioning
Breathing exercises
Relaxation techniques

31
Q

What allows for detainment of people under MCA

A

DOLS

32
Q

Does MCA require mental health disorder

A

No

33
Q

What is an advanced decision to refuse treatment

A

Verbal statement that has to be in writing to have legal relevance

Can only be overridden if another individual has LPA for health and welfare

General practice (26 decks)

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