Palliative Care Flashcards
o Starting doses for oromorph?
2.5-5mg, 4-hourly
if pain not 90% relieved, how much should the dose be increased by?
o Increase by 1/3rd (30-50%)
o Breakthrough doses of morphine should be what?
= 1/6th of total morphine in 24 hours
Bony metastasis pain:
1st: Analgesia
2nd: Bisphosphonates
3rd: Radiotherapy
- Immediate release morphine formualations: (IR; ≤4 hours):
o Oromorph (liquid)
o Sevredol (tablet)
o Morphine injection
- Modified release morphine (MR):
o MST / zomorph (BD)
o MXL (OD)
Metoclopramide - avoid in which patients?
- Avoid in Parkinson’s (DA antagonist) – use domperidone (does not cross BBB)
- Avoid in young women (risk of dyskinesia i.e. acute dystonia)
Which anti-emetic to prescribe in fluid retention?
Metoclopramide, avoid cyclizine
Vestibular N&V drug choice?
Cyclizine
Raised ICP N&V drug choice?
Cyclizine (± dexamethasone)
Chemical N&V drug choice?
Ondansetron, haloperidol, levomepromazine
Which drug for chemotherapy nausea?
Ondansetron
Gastric stasis N&V drug choice?
Metoclopramide (CI: BO), domperidone
Constipation, oral candidiasis N&V drug choice?
Cyclizine, levomepromazine
Anxiety, pain, fear, anticipatory nausea N&V drug choice?
BDZ (lorazepam), cyclizine
2nd line Mx for agitation/confusion?
o 2nd line: chlorpromazine, levomepromazine
Terminal restlessness treatment?
Midazolam (PRN SC injections or SC infusion by syringe driver)
Treatment for excess secretions?
o Medical:
1st line: hyoscine hydrobromide / butylbromide
2nd line: glycopyrronium bromide
Hiccups mx in palliative care?
- Management:
o 1st line: chlorpromazine
o 2nd line: haloperidol, gabapentin
o Hepatic lesions: dexamethasone
Treatments for neuropathic pain?
Amitriptyline, gabapentin, pregablin, duloxetine
Which cancers are most likely to cause Bone metastases?
Precious bone killed through lesions
Prostate, breast, kidney, thyroid, lung
Marker of bone degeneration?
ALP
Most common histological prostate cancer?
Adenocarcinoma
Tx for intermediate/high grade prostate cancer?
Radical prostectomy
Types of breast cancer?
Ductal carcinoma in situ, lobular carincoma in situ, invasive ductal carcinoma, invasive lobular carcinoma, paget’s disease of the breast, inflammatory breast cancer
Sites of metastasis in breast cancer?
Lung, liver, bone, brain, adrenals
Treatment for HER2 positive breast cancer?
Herceptin
ER/PR positive breast cancer treatments?
Pre-menopausal = tamoxifen
Post-menopausal = aromatase inhibitors: letrozole, anastrozole
Small cell lung cancer buzzwords?
Cushing’s syndrome (ACTH production)
SIADH ( ADH production)
Large cell lung cancer buzzwords?
Gynaecomastia
Squamous cell lung carcinoma buzzwords?
Hypercalcaemia secondary to PTHrp production
Adenocarcinoma of the lung buzzwords?
Low smoking risk, most common
Tx for SVCO?
Give dexamethasone
Might need intubation
Diuretics
Endovascular stenting
What is adjuvant chemotherapy?
Given AFTER surgery
What is neo-adjuvant chemotherapy?
Given before surgery to help reduce the size of the tumour
Tx for end of life breathlessness?
oral morphine, midazolam
Conversion from oral to SC morphine?
x0.5
Conversion from oral to SC diamorphine?
x0.33
Conversion from morphine to tramadol?
x10
Conversion from oral morphine to oral oxycodone?
x0.5
Conversion from morphine to codeine?
x10
Conversion from morphine to pethidine IV?
x2.5
Conversion from morphine to fentanyl IV?
x0.005
