Palliative Care Flashcards
What are the syndromes of frailty? (5)
- A new confusion or delirium
- Increased falls
- Incontinence
- Reduced mobility
- Increased susceptibility to medication
Why is palliative care such a complex ‘balancing act’? (3)
They are more likely to have:
- Multiple long-term conditions
- Polypharmacy
- Complex needs, both clinically and socially
What conditions can lead palliative patients to be more susceptible to falls? (11)
- Urinary incontinence
- Dementia
- Parkinson’s
- Diabetes
- Heart disease
- Stroke
- Osteoarthritis
- Atrial fibrillation
- Sarcopenia
- Peripheral neuropathy
- Pain
How can medication cause falls? i.e. which 3 classes of drugs have the highest propensity to cause falls? (3)
- CNS (psychotropic drugs): cause drowsiness, also some cause postural hypotension
- The heart and circulation: causes syncope due to hypotension or bradycardia
- Blood sugars: cause hypoglycaemia
What conditions can cause sedation? (4)
- Hypothyroidism
- Insomnia
- chronic pain
- Depression
Which drugs can cause sedation? (7)
- Benzodiazepines
- Z-drugs (insomnia)
- Sedating antihistamines
- Sedating anti-depressants
- Drugs with high cholinergic burden e.g. warfarin, metoprolol
- Opioids
- Dopamine agonists e.g. levodopa
What conditions can cause dizziness?
- Parkinson’s
- Stroke
- MS
- Peripheral neuropathy
- Meniere’s (changes in fluid volume in inner ear- causes vertigo)
- Labyrinthitis (inner ear infection)
What conditions can cause postural hypotension?
- Parkinson’s
- Heart failure
- Dehydration
- Infection
Which drugs can cause postural hypotension (7)
- Alpha-blockers (treatment of prostatism) e.g. Tamulosin
- Diuretics
- Levodopa
- Calcium Channel blockers e.g. AmlodoPINE, Diltiazem
- Nitrates
- Sedating antidepressants
- Serotonin and norepinephrine inhibitors e.g. Duloxetine
How can postural hypotension be managed in patients?
- Can be resolved with rehydration or removing the causative drug
- IF not, Midodrine and Fludrocortisone can increased BP
AVOID FLUDROCORTISONE IN HEART FAILURE
Which conditions can cause visual impairment? (5)
- Stroke
- Diabetic retinopathy (damage to retinas)
- Macular degeneration
- Dry eyes
- Glaucoma (increased blood pressure in eyes)
Which drugs can cause visual impairment? (5)
- Benzodiazepines
- Sedating antihistamines
- Sedating anti-depressants
- Drugs with high anticholinergic burden e.g. Warfarin, Metoprolol
- Alpha-blockers e.g. Tamsulosin
Which conditions can cause hypoglycaemia? (4)
- Diabetes
- Renal failure
- Malnutrition
- Hormone deficiencies
Which drugs can cause hypoglycaemia?
- Beta-blockers e.g. Atenolol
- Sulphonylureas (for diabetes) e.g. Gliclazide
- Insulin
What are the principles of diabetes management plan in palliative patients? (6)
- Consider de-escalation of therapy
- NPH insulin is 1st line (if absolutely necessary)
- Do not restrict diet (if low/losing weight)
- Generally AVOID starting starting Sulphonylureas e.g. Gliclazide in elderly
- SGLT-2 inhibitors and DPP4 inhibitors are okay as 2nd line
- Usually AVOID Pioglitazone –> risk of fractures, heart failure, bladder cancer etc
Which conditions can cause confusion/delirium? (8)
- Infections- particularly UTIs and respiratory
- Hypoxia- HF, anaemia, COPD
- Metabolic- dehydration, low Na, hypoglycaemia, thyrotoxicosis (too much thyroid hormone)
- Constipation
- Pain
- Urinary retention –> can lead to UTI
- Hypothermia
- Multiple organ failure
Which drugs can cause confusion/delirium?
- Benzodiazepines- common on start of treatment
- PPIs e.g. Omeprazole, loop & thiazide diuretics e.g. Furosemide- due to hyponatraemia
- Z-drugs e.g. Zopiclone
- Opioids
- Dopamine agonists
- Steroids- dose related risk
- Drugs with high anticholinergic burden e.g. Warfarin, Metoprolol
- Drug withdrawal e.g. alcohol, opioids, benzodiazepines
Which conditions can cause dehydration? (7)
- Diarrhoea
- Vomiting
- Dementia
- Infection
- Fever
- Surgery
- Drains
Which drugs can cause dehydration? (3)
- Diuretics
- Laxatives
- Colchicine (treat gout)
What form of urinary issues is considered an emergency?
Acute urinary retention = abrupt inability to pass urine
What are the options for urinary incontinence in palliative care?
- Occupational therapist review of home e.g. install toilet next to bed
- Mirabegron (no high anticholinergic burden)
- Review of Furosemide and drugs with high water content
What are the options for urinary retention in palliative care?
- IF EMERGENCY = catherization
- Constipated? Laxatives and find root cause
- Benign prostatic hyperplasia? Alpha-blockers e.g. Tamsulosin or 5-Alpha reductase inhibitors e.g. Finasteride
