Palliative Care Flashcards
The WHO performance status classification categorises patients as [4]
0: able to carry out all normal activity without restriction
1: restricted in strenuous activity but ambulatory and able to carry out light work
2: ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours
3: symptomatic and in a chair or in bed for greater than 50% of the day but not bedridden
4: completely disabled; cannot carry out any self-care; totally confined to bed or chair.
Background of morphine given based on their 24hr requirements AND PRN dose available for breakthrough pain
- PRN dose: 1/6th to 1/10th of 24hr dose
- Consider prescribing laxative
TOM TIP: Remember that each rescue dose is 1/6 of the 24-hour background dose. This is a very common exam question and something that seniors will commonly ask to test your knowledge.
Whats the MoA of opioids? [1]
Agonist activity at opioid receptors in central and peripheral nervous system. There are three major classes of opioid receptors:
* Mu - predominately work on these
* Delta
* Kappa
Why may opioids cause itchiness? [1]
Pruritus: Opioids may induce histamine release, resulting in pruritus and other allergic-type reactions.
When would you not give morphine to patients? [1]
Which alternative medications could you give them? [1]
Poor renal function makes morphine CI:
- alternatives include: oxycodone, alfentanyl or buprenorphine.
What should you specificially monitor for in patients being given opioids? [3]
Monitor for signs of opioid toxicity
- respiratory depression
- sedation
- myoclonus
switch to alternatives or dose reduce as necessary.
How would you treat breathlessness? [4]
Non-pharmacological:
- Sit up
- Give a fan / open window
Pharmacological:
- Low dose opioids
- Benzos
- Therapeutic oxygen
Which medication would you give for a patient that has gastric stasis
Metoclopramide
Cyclizine
Ondansetron
Haloperidol
Levomepromazine
Hyoscine
Which medication would you give for a patient that has gastric stasis
Metoclopramide
Cyclizine
Ondansetron
Haloperidol
Levomepromazine
Hyoscine
Which medication would you give for a patient that has motion sickness
Metoclopramide
Cyclizine
Ondansetron
Haloperidol
Levomepromazine
Hyoscine
Which medication would you give for a patient that has motion sickness
Metoclopramide
Cyclizine
Ondansetron
Haloperidol
Levomepromazine
Hyoscine
For chemically-mediated symptoms (for example medications, metabolic derangemenet), aim to treat the underlying cause.
If needed, which anti-emetics could be used? [3]
Antiemetics that may be helpful include haloperidol, metoclopramide or levomepromazine.
Which medication would you give for a patient that feels sick because of raised ICP?
Metoclopramide
Cyclizine
Ondansetron
Haloperidol
Levomepromazine
Hyoscine
Which medication would you give for a patient that feels sick because of raised ICP?
Cyclizine
- Dexamethasone or radiotherapy may be helpful to reduce the pressure-associated symptoms.
Which medication should be given to patients who feel nauseous due to compression from abdominal or pelvic tumours? [1]
cyclizine should be used first-line.
Which medications can you give for agitation in end of life? [2]
For patients in their last days of life, haloperidol or low-dose midazolam may be prescribed
Which medications can be given for respiratory tract secretions in end of life care? [2]
An antimuscarinic such as hyoscine butylbromide or glycopyrronium bromide may be prescribed for noisy respiratory secretions.
“this patient is on 30mg of modified-release morphine every 12 hours; what would be the correct breakthrough dose?” [1]
10mg is the correct answer, as the patient is getting 60mg background morphine every 24 hours (30mg twice a day).
if the patient is getting 30mg in 24 hours of modified-release morphine (15mg every 12 hours), what is the rescue dose needed? [1]
5mg
Describe the three steps to the analgesics ladder
- Step 1: Non-opioid medications such as paracetamol and NSAIDs
- Step 2: Weak opioids such as codeine and tramadol (tramadol has multiple mechanisms of action, including being an SNRI and agonist of opioid receptors)
- Step 3: Strong opioids such as morphine, oxycodone, fentanyl and buprenorphine
What is a key side effect of analgesic medication? [1]
Medical overuse headache is a common side-effect of the long-term use of analgesic medication.
NSAIDS may be inappropriate in which patients? [5]
NSAIDs may be inappropriate or contraindicated in patients with:
* Asthma
* Renal impairment
* Heart disease
* Uncontrolled hypertension
* Stomach ulcers
The key side effects of NSAIDs are: [6]
Gastritis with dyspepsia (indigestion)
Stomach ulcers
Exacerbation of asthma
Hypertension
Renal impairment
Coronary artery disease, heart failure and strokes (rarely)
[] is used to reverse the effects of opioids in life-threatening overdose (usually due to respiratory depression).
Naloxone is used to reverse the effects of opioids in life-threatening overdose (usually due to respiratory depression).
What are 5 key side effects of opiods? [5]
- Constipation
- Skin itching (pruritus)
- Nausea
- Altered mental state (sedation, cognitive impairment or confusion)
- Respiratory depression (usually only with larger doses in opioid-naive patients)
In general, NSAIDs are used in the management of pain.
Specific indications include:
mefenamic acid: [1]
In general, NSAIDs are used in the management of pain.
Specific indications include:
mefenamic acid: dysmenorrhoea
Which drugs increase the risk of peptic ulcers if given with NSAIDS? [4]
SSRIs, corticosteroids, bisphosphonates; anticoagulants
