Palliative Care Flashcards
What is palliative care?
- Holistic care of patients with advanced progressive illness
What does palliative care involve?
- Pain management
- Management of other symptoms
- Psychological, social and spiritual support
Goal of palliative care
Achieve best QoL for patients and their families
Conditions you would expect to see in palliative care
- Cancer
- Respiratory diseases
- Organ failure
- HIV/AIDs
- Neurological conditions e.g. MS, PD, AD, MND
- Frailty
Individuals involved in palliative care
- Nurse specialists
- Pharmacists
- Psychologists
- OT
- Physio
- Social worker
- Medical staff
- Volunteers
How is palliative care delivered
- Outpatient/inpatient units
- Day Hospice
- Hospice at home
- Charities
Role of pallative care team in supporting carers
- Juggling responsibilities, respite
- Emotional support
- Financial support
- Making difficult decision, legal issues, planning ahead
- Bereavement: death certificate, notifying people, probate, funeral arrangements
Role of pallative care team in supporting patients
- Telling family/friends/children you are dying
- Making a will
- Planning your funeral
- Organ donation
- Power of attorney
- Where you would like to die
- Specialist equipment
- Just in case medicines
Pharmacist role in palliative care
- Dose recommendations and conversions
- Drug interactions
- IV/Syringe driver compatibility, dilutions, rate of infusion
- Patient monitoring
- Review of long term medications
- Drug Induced vs disease induced symptoms
- Drug handling – comorbidities
- Controlled drug prescribing and disposal
- Unlicensed drug advice
- Consultations
- Writing policies and guidelines
- Supply EoL medication for patients at home
What is the pharmacist’s role in concordance?
- Emphasise adherence - large numbers of medications, complex regimes
- Discuss alternative formulation/treatments
What is the pharmacists role in patients beliefs about medication
- Use of opioids
- Fear of dependence, tolerance
- Alternative treatments
Key symptoms in palliative care
- N + V
- Dysphagia
- Odynophagia (painful swallowing)
- Dyspnoea
- Fatigue
- Bone pain
- Constipation
- Anorexia (lack of appetite - not the ED)
- Xerostomia (dry mouth due to lack of saliva)
- Anxiety
- Depression
Common SE of analgesia
- Constipation
- Drowsiness
- Confusion
- Xerostomia
- Fatigue
- Hypotension
- Hallucinations
- N + V
Pain
- An unpleasant sensory and emotional experience associated with actual or potential tissue damage.
- Subjective
- Consider all aspects of pain:
- Physical aspects
- Social aspects
- Physiological aspects
Principles of pain management
- Understand cause to optimize treatment
- Appropriate level of WHO ladder
- Use adjuvants where necessary
- Use oral where possible
- Assess regularly
- Encourage patients to take an active role in the management of their pain
Causes of pain
- Nociceptive
- Somatic
- Visceral
- Neuropathic
Opioids for pain management
- 1st line = morphine
- Background and breakthrough
Breakthrough pain management
- Regular opioid + Breakthrough opioid
- Regular opioid = typically long acting 12 or 24 hour preparations.
- Breakthrough = immediate release preparations, given PRN when pain worsens.
Monitoring
- Pain charts
- Individual dose titration
Syringe drivers
- SC
- Steady plasma conc. of drug
- Dose reviewed every 24 hours, titrated up/down as needed - dependent on symptoms/side effects.
- May still require breakthrough doses
When are syringe drivers useful?
- Intractable pain
- Vomiting
- Severe dysphagia (patient too weak to swallow or unconscious)
- Several drugs can be combined into one syringe - management of multiple symptoms.
Compatibility charts
- For syringe drivers
- Summarises compatibility information available for drug combinations
- Determines if drugs can be mixed or if they will precipitate
- Maximum concentrations
3 examples of palliative care emergencies
- Malignant hypoercalcaemia
- Neutropenic sepsis
- Malignant spinal cord compression (MSCC)
Malignant hypercalcaemia
- Palliative care emergency
- Sign that disease has significantly progressed (most paitnets with this die within a year)
- Ca> 2.6mmol/Lt
Malignant hypercalcaemia - treatment
- Fluid replacement (1-2L NaCl 0.9% over 24h)
- Given before bisphosphonates as nephrotoxic.
- Bisphosphonates: zolendronate or pamidronate
- Treatment effective for 2-4 weeks in 70-80% of pt
- Reduce dose in renal impairment
- Ca2+ levels fall after 48h and continue to decrease for 6/7 days
- Monitor
Zolendronate
4mg/100ml in normal saline for 15 mins