Palliative care Flashcards

1
Q

managing agitation and confusion

A

treat underlying cause

haloperidol
chlorpromazine, levomepromazine

if terminal - midazolam

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2
Q

managing hiccups

A

chlorpromazine
haloperidol
gabapentic
dexamethasone if hepatic lesions

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3
Q

causes of nausea and vomiting in palliative care patients

A

reduced gastric motility - due to opioids

chemical - due to hypercalcaemia, opioids, or chemotherapy

visceral/serosal - due to constipation

raised ICP - due to cerebral mets

vestibular - activation of Ach and H1 receptors in opioid use

cortical - due to anxiety, pain

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4
Q

treating N/V due to reduced gastric motility

A

Pro-kinetic agents to reduce gastric dysmotility and stasis

metoclopramide, domperidone

do not use if prokinesis may negatively affect GI tract e.g., in bowel obstruction

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5
Q

treating chemically mediated N/V

A

correct chemical disturbance

treat with ondansetron, haloperidol, levomepromazine

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6
Q

treating N/V due to visceral/serosal causes

A

Cyclizine and levomepromazine are first-line
Anti-cholinergics such as hyoscine can be useful

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7
Q

treating N/V due to raised ICP

A

cyclizine
dexamethasone

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8
Q

treating N/V due to vestibular causes

A

cyclizine

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9
Q

treating N/V due to cortical causes

A

short acting benzo, lorazepam
cyclizine

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10
Q

starting pain treatment in palliative care

A

regular oral modified-release (MR) or oral immediate-release morphine - 20-30mg MR

oral immediate-release morphine for breakthrough pain - 5mg (oral >patches)

give laxatives

counsel re nausea and drowsiness

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11
Q

SIGN guidelines

A

breakthrough dose of morphine is one-sixth the daily dose of morphine

patients who receive opioids should be prescribed a laxative

use opioids with caution if with CKD - oxycodone preferred if renal impairment

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12
Q

increasing opioid doses

A

each dose increase should be by 30-50%

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13
Q

other pain medication used to manage palliative pain

A

In addition to strong opioids, bisphosphonates and radiotherapy, denosumab may be used to treat metastatic bone pain.

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14
Q

conversions in opioid medication

A

oral codeine/tramadol to oral morphine - divide by 10

oral morphine to oral oxycodone - divide by 1.5-2

morphine oral to SC - divide by 2

morphine oral to SC diamorphine - divide by 3

oral oxycodone to SC diamorphine - divide by 1.t

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15
Q

managing excess secretions in palliative care

A

Avoiding fluid overload

hyoscine hydrobromide or hyoscine butylbromide (less sedative)

glycopyrronium bromide

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16
Q

commonly used drugs in palliative care

A

nausea and vomiting: cyclizine, levomepromazine, haloperidol, metoclopramide

respiratory secretions/bowel colic: hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide.

agitation/restlessness: midazolam, haloperidol, levomepromazine

pain: diamorphine is the preferred opioid