Palliative care Flashcards

1
Q

Which Benzo for breathlessness

A

Lorazepam 0.5mg PRN SL
-> short acting benzo

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2
Q

Which laxative would you avoid in palliative care and why?

A

bulk forming diuretics

can’t use with poor oral intake or poor bowel motility

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3
Q

Summarise the different types of laxatives

A
  • softening agents -> lubricate the stool (e.g. liquid paraffin/milpar)
  • bulking agents -> increase faecal mass stimulating peristalsis (e.g. Bran, fybogel)
  • stimulant agents -> increase intestinal motility (e.g. senna or bisacodyl)
  • osmotic agents -> pull liquid into stool (e.g. macrogol)
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4
Q

What are the common symptoms at the end of life?

A

pain
agitation/distress/anxiety
respiratory tract secretions
breathlessness
N&V

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5
Q

PC management of breathlessness

A
  • treat reversible cause
  • oxygen if hypoxic
  • morphine sulfate immediate release 1mg PO PRN / sustained release 5mg BD
  • manage anxiety component with therapies, mindfulness etc or: LORAZEPAM 0.5 mg PRN SL

-> short acting benzo

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6
Q

Which antiemetic for central causes?

main SE

A

cyclizine

irritant SC
severe HF - avoid

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7
Q

Which antiemetic post chemo/abdo surgery / abdo radiotherapy?

main SE

A

ondansetron

-> very constipating, QT prolongs

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8
Q

Which antiemetic for chemical causes?

A

chemical causes = renal failure, drug induced, acid base imbalance..

Haloperidol

Risks: lowers seizure threshhold, avoid in Parkinsons

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9
Q

Which antiemetic for delayed GIT transit/obstruction without colic?

A

metoclopramide / domperidone

risks:
BO with colic
Parkinsons
cardiac conduction disorders
young women - SE movement disorders

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10
Q

3rd line antiemetic for all causes

A

levopromazine

risks: long half life, sedating, lowers seizure threshold, severe HF, CVD and PD

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11
Q

Which opioids are safe in renal failure

A

buprenoprhine
fentanyl
alfentanyl

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12
Q

Common anticipatory medications

A

PAIN
- morphine sulfate
(oxycodone alternatively)

SECRETIONS
Glycopyrronium
(alt: hyoscine butylbromide, butylbromide (buscopan))

AGITATION/DISTRESS
- Midazolam

BREATHLESSNESS
- Midazolam
or
- Morphine

N&V
- Haloperidol
(alt: cyclizine)

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13
Q

What is never the correct route in palliative care?

A

IM

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