Palliative Care Flashcards
What is meant by palliative care?
Approach to improve quality of life of patients and families in life-threatening illnesses
Focus on prevention and relief of suffering
Considers physical, psychological and spiritual health
What are some common symptoms in end of life patients?
Nausea and vomitting
Pain
Constipation
Pruritis
Dehydration
Insomnia
Oral problems
Agitation
Breathlessness
Excess respiratory secretions
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What are the three main steps on the WHO analgesic ladder?
Step 1 = non-opiods (paracetamol or NSAIDs)
Step 2 = weak opiods (Codeine, tramadol)
Step 3 = strong opiod (Morphine, oxycodone and fentanyl)
What level of pain relief do end of life patients typically require?
Step 3 - strong opiods
Morphine, Oxycodone, methadone, buprenorphine, fentanyl
When should morphine be offered as a pain killer in end of life?
Severe pain - that persists or increases
Strong opioid (level 3)
Avoid when eGFR <30ml/min
Under what conditions is oxycodone used for end of life pain relied?
For severe pain
Is a step 3 pain relief = strong opioid
Safe to use when eGFR <30ml/min
What different medications may be used for nausea and vomiting in palliative care?
Cyclizine
Haloperidol
Domperidone
Metoclopramide
Ondansetron
Levomepromazine
What is the use and side effects of cyclizine in palliative care?
Reduces nausea and vomiting
Is an anti-histamine = targets H1 receptors
Side effects = anti-muscarininc - dry mouth, urinary retention, constipation, blurred vision, drowsiness
What is the use of haloperidol in palliative care?
What are its side effects?
Reduce nausea and vomiting
First gen anti-psychotic
D2 receptor antagonist - crosses the BBB
Side effects - QT prolongation, parkinsonism, dystonia, akathisia, tardive dyskinesia
What is the use of domperidone in palliative care?
What are the side effects?
Is used to reduce nausea and vomiting
Is a prokinetic - moves food through the GIT, D2 receptor antagonist.
Doesn’t cross the BBB
Side effects: anti-muscarinic dry mouth, urinary retention, blurred vision
What is the use of metoclopramide in palliative care?
What are its side effects?
Is used to reduce nausea and vomiting
DR receptor antagonist - crosses the BBB
Side effect - anti-muscarinic
What is the use of metoclopramide in palliative care?
What are its side effects?
Reduced nausea and vomiting
D2 receptor antagonist, crosses the BBB.
Side effects = antimuscarinic symptoms, extrapyramidal symptoms
CONTRAINDICATED in Parkinsons disease
What is the use of ondansetron in palliative care?
What are its side effects?
Used to reduce nausea and vomitting
Is a 5HT-3 receptor antagonist
Side effects - QT prolongation, headaches, constipation, involuntary movements
What is the use of levomepromazine in palliative care?
What are its side effects?
Is used to reduce nausea and vomiting
Is a first gen anti-psychotic - acts on H1, dopamine and Ach antagonist
Side effects - antimuscarinic, extrapyramidal, QT prolongation, postural hypotension,
CONTRAINDICATED in parkinsons disease.
What methods of de-escalation can be used for agitation in palliative care?
Familiar staff and visitors
Orientation
Hearing and visual aids
Clear and concise communication
Calm and empathetic approach.
What can be used to treat agitation in palliative care?
Benzodiazepines: midazolam, lorazepam
Reassurance and de-escalation
Treating to underlying cause
What non-drug methods are used to treat respiratory secretions in palliative care?
Patient positioning and secretion suctioning
What drugs can be used to treat respiratory secretions in palliative care?
Hyoscine butyl bromide
Glycopyrronium bromide
Can be PO/IM/SC/IV
Anti-muscarinic agents - reduce smooth muscle contraction
Also used for bowel colic
How can breathlessness be treated in palliative patients?
Morphine
Lorazepam
Intervention - thoracentesis for pleural effusions
How are most anticipatory medications given to patients?
Subcutaneous syringe driver
What are the common anticipatory medications and their indication in palliative care?
Pain = morphine
N&V = cyclizine
Agitation = midazolam
Resp secretion = Hyoscine butylbromide
Breathlessness = morphine/midazolam
How is constipation treated in palliative care patients?
Laxatives
Good oral intake
How is pruritis treated in palliative patients?
Antihistamines
Lotions and emollients.
How is dehyrdation and oral problems treated in palliative care?
Oral intake as able
Artificial saliva
Mouth wetting with sponge
How is insomina treated in palliative care patients?
Good sleep hygeine
Review potential contributing meds
Consider benzos or hypnotics
