Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AKT - Lizzie Bain > Palliative care > Flashcards

Palliative care Flashcards

1
Q

How is oral morphine converted into SC diamorphine?

A

Divide the 24hr morphine dose by three

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is oral morphine converted to oral oxycodone?

A

Divide the 24 hour morphine dose by 1.5

oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the standard prn ‘rescue dose of morphine for breakthrough pain?

A

1/6th of the total daily dose of morphine (24hr dose) prn every 2-4 hours as required.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What frequency of prn use should prompt a pain management review for a patient on morphine?

A

use of prn doses BD or more.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When increasing the regular morphine dose, what should be the maximum dose increment?

A

the increase should not be more than 1/3 to 1/2 of the TDD every 24 hours. (by 30-50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the options for analgesia for patients where morphine is not tolerated or is ineffective?

A
  • seek specialist advice on use of oxycodone, buprenorphine, fentanyl or hydromorphone.
  • Before swithcing - ensure adjuvant analgesic options have been explored.
  • ensure you have attempted to manage side effects.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How should a switch from morphine to another opioid be managed to ensure safety?

A
  • the calculated equivalent dose should be reduced. Reduce dose by 25-50%. Reduce by 50% if high dose.
  • seek specialist advice before switching if on high dose morphine >=120mg/24hrs.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is PO codeine converted to PO morphine?

A

Divide 24h Codeine dose
by 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is PO dihydrocodeine converted to PO morphine?

A

Divide 24h Dihydrocodeine
dose by 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is PO tramadol converted to PO morphine?

A

Divide 24h Tramadol dose
by 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is PO morphine converted to SC morphine?

A

Divide 24h Morphine dose
by 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is PO oxycodone converted to SC oxycodone?

A

Divide 24h Oxycodone dose
by 1.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the ratio of PO morphine to transdermal fentanyl?

A

100:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is PO morphine (mg/24h) converted to transdermal fentanyl (micrograms/h)?

A

divide the 24 hour dose of morphine by 24 - this is the hourly morphine dose in mg.

(technically you would divide by 100 to get to the equivalent hourly fentanyl dose in mg. Then x1000 to convert mg to micrograms)

In short, just multiply by 10. This gives the fentanyl patch dose as micrograms/hr.

This is the same for converting PO morphine in mg over 24hrs to buprenorphine patch in micrograms/hr (also 100:1).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the ratio of PO morphine to transdermal buprenorphine?

A

100:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the options for neuropathic pain in palliative care?

A
  • antidepressants - AMT, duloxetine, notriptyline. and
  • gabapentinoids - gabapentin, pregabalin are 1st line for both cancer and non-cancer related.
  • can combine antidepressant and gabapentinoid if pain uncontrolled with single drug
  • steroids an alternative for cancer related neuropathic pain, esp if pain due to SC or or nerve compression.
  • specialist advice if persists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the options for painful chronic muscle spasm, spasticity and cramp?

A
  • skeletal muscle relaxants: baclofen 1st line
  • diazepam or midazolam alternatives (esp if duration <4w)
18
Q

What are the options for anorexia (loss of appetite)?

A
  • early satiety due to delayed gastric emptying: trial of prokinetic - metoclopramide or domperidone
  • dexamethasone, pred or progestogen (if long term Rx needed) - can be used to stimulate appetite (stop if no benefit at 1-2w)
19
Q

How can bowel colic be treated?

A

hyoscine butylbromide

ensure stool softened.

20
Q

How can constipation be treated?

A

All pts prescribed strong opioid should be given a regular laxative.
* stimulant - senna or bisacodyl recommended. (unless Hx of colic with stimulants)
* add osmotic if no response (macrogol or lactulose)
* add docusate sodium if not responded or Hx colic.
* oral ineffective - glycerol or bisacodyl supps, or micro enema sodium citrate.
* phosphate enema if above not worked.

21
Q

What can be given for dysphagia?

A
  • dexamethasone if obstruction due to tumour
  • SL GTN before meals - if due to oesophagitis and oesophageal spasm.
22
Q

What should patients be advised about nausea when starting opioids?

A

nausea may occur when starting (and titrating) strong opioids, but it is likely to be transient and improve after 5-7 days.

23
Q

Which antiemetic is best for N&V due to gastric stasis, gastritis and functional bowel obstruction?

A
  • metoclopramide or domperidone - prokinetic action.

Stop any antimuscarinics - they antagonise the prokinetic drugs

24
Q

Which antiemetic is best for chemical causes of vomiting? (hypercalcaemia, morphine use, renal failure)

A

Haloperidol

25
Q

Which antiemetic is best for N&V due to raised ICP and/or vestibular dysfunction?

A

cyclizine (with dexamethasone for raised ICP)

26
Q

Which antiemetic can be started if there is little effect with 1st line antiemetics despite increasing dose?

A

switch to levomepromazine - broad spectrum antiemetic.

27
Q

Which antiemetics can be used for prevention of acute symptoms of N&V due to chemotherapy?

A
  • low risk of emesis: dexamethasone or lorazepam pre treatment
  • high risk of emesis: ondansetron with dexamethasone and aprepitant.
28
Q

Which antiemetics can be used for prevention of delayed symptoms of N&V due to chemotherapy?

A
  • moderately emetogenic chemo: ondansetron and dexamethasone
  • highly emetogenic: aprepitant and dexamethasone.

lorazepam can help prevent anticipatory symptoms.

29
Q

What are the options for agitation?

A
  • anxiety prominent: benzo
  • delirium prominent: haloperidol.
30
Q

What are the options for anxiety?

A
  • prognosis days-weeks: midazolam/diazepam/lorazepam
  • prog of months - SSRI +/- benzo.
  • CBT can be equally effective
31
Q

What are the options for depression?

A
  • SSRIs first line (sertraline or citalopram)
  • mirtazapine if also have nausea, insomnia or reduced appetite.
  • SNRI e.g duloxetine if also neuropathic pain.
32
Q

What are the options for seizures?

A
  • if there is a history of seizures - levetiracetam preferred 1st line - can be rapidly titrated and few interactions.
  • in last days of life - midazolam preferred as benefits other symptoms and compatible with other drugs in CSCI.
33
Q

What are the options for breathlessness?

A
  • non drug: breathing techniques, positioning, fan
  • if wheeze - 1-2 wk trial bronchodilator.
  • corticosteroid - if due to airway obstruction, pnuemonitis (post-radiotherapy), airway compression, lymphangitic carcinomatosis.
  • where underlying causes cannot be corrected - morphine low doses.
  • if anxiety related and morphine not helped - benzo or SSRI
  • in last days of life - opioid plus benzo best.
34
Q

What are the options for hiccups?

A
  • due to gastric distension: metoclopramide, simeticone or peppermint oil, or PPI
35
Q

What are the options for intractable cough?

A
  • if sticky sputum - neb NaCl and mucolytics.
  • consider physio and SALT
  • dry cough - simple linctus or citric acid. Can add opioid (morphine).
36
Q

What can be done for noisy airway secretions causing distress?

A
  • non drug - positioning
  • antimuscarinic - hyoscine butylbromic or glycopyrronium bromide SC.
37
Q

What can be done for Malodourous fungating tumours?

A
  • topical or systemic metronidazole.
38
Q

What can be done for pruritis?

A
  • if due to drug - review
  • emollient
  • topical antipuritic e.g. levomethol cream
  • trial antihistamine
  • specialist advice: SSRI for cholestatic pruritis, gabapentinoids for uraemia.
39
Q

Oxycodone can be used instead of morphine in renal impairment. What is the cut off for eGFR acceptable for oxycodone use?

A

can be used unless the eGFR is less than 10 mL/minute/1.73 m2

40
Q

How do you convert PO morphine to PO hydromorphone?

A

divide by 5

AKT - Lizzie Bain (55 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions