Palliative Care Flashcards
What is the difference between palliative care and end of life care are
Palliative:
• for any age group
• those who’s modifying disease treatment is no longer effective or available
• for those experiencing uncontrolled disease related symptoms
• holistic approach - support: physical, emotional, psychological and spiritual
End of life:
• provides dignity for those who are dying
• live comfortably before passing
• manages physical symptoms
• emotional support for family and friends and concelljng on what to expect near the end of life
• practice support for finance or wills
Palliative care - drug stockist scheme?
Provides access to palliative drugs in community pharmacies
But only available to pharmacies who agree to it
What resources can be used for symptoms control in palliative care (ie guidance)
• BNF
• palliative care folumary
• palliative care matteres
• the syringe driver
• NEWT
• local guidlines
• NICE
• CKS
What is an off label medicine
A medicine which has a licence but the licence doesn’t cover the indication/dose/route it is being used for
(2/3 palliative care patients will receive off label medicine)
What is a unlicensed drug
A drug which doesn’t have a license for any indication in the uk
WHO analgesic - 3 steps
Step 1 - non opioid
• paracetamol
• NASIADs
Step 2 - weak opioids
• codeine
• dihydrocodiene
Step 3 - strong opiods
• morphine
• methadone
• oxycodiene
• fentanyl
Don’t give these PRN
All can be given with adjuvants
Common ADRS of opiods
• constipation
• dry mouth
• hallucinations
• headaches
• N&V
Why is morphine first line
• a lot of evidence fir its use
• no ceiling affect
• predictable affect
• comes in different form
• wide therapeutic range
If there’s renal impairment what would you give
Oxycodone
Management of Bone paid
• Radiotherapy
• biphosphanatea
• NSAIDs
Start with the pain ladder - biphosphates as an adjuvant
Examples of biphosphonates and when they should be reviewed
• alendronic acid
• risedronate sodium
• Ibandronic acid
^ 5 years review
•Zoledronic acid
^ 3 years
Treatment might be extended for those over 75, hx of hip featurs or on long glucocorticoids
What can cause N&V and what is the management
Causes:
Drugs which cause hypercalcium: thaizaide like diuretics, vit D and malignancy
Management- non pharm
• cold fizzy drinks
• small portion meals and more snacking
• avoid smell of hot foods
Step 1: either of
• metoclopramide
• cyclizine
• halperidol
Step 2
• levomepromazine
Step 3 - dual
• levomepromazine + ondansetron
Pharmacological management of constipation in elderly
Bisacodyl or senna
Pharmacological management of consumption- if optiod induced
Senna
Elderly - co-danthrustate
Pharmacological management of anxiety
• SSRI - fluoxetine
or
• BZD - diazepam
Pharmacological management of delirium
Antipsychotic - halperidol
Pharmacological management of Agitation
• BZD
or
• antipsychotic - haloperidol
If COPD or asthma is the cause of breathlessness what would be the pharmacological management
SABA or SABA + SAMA
If underlying cause of can not be fixed, what would you give
Morphine
Pharmacological management of respiratory secretions aka death rattle
Antimuscrinics:
• hyoscine butylbromide
• glycopyrronium bromide
When are syringe drivers used?
• coma
• bowel obstruction
• persistent nausea & vomiting
• unable to take oral
• multiple and repeated dosing
Advantages and disadvantages of of syringe driver
Advantages:
• don’t need multiple injections
• can use multiple drugs
• portable
• saves nurses time
• continuous administration = maintenance of therapeutic dose
Disadvantage:
• pain at injection time
• expensive
• not all drugs can be give this way
• training of staff
What needs to be written in a syringe driver prescription:
• doses
• duration of infusion
• dilutent
• end volume of infusion
Problems either syringe driver
• over dose
• under dose
• drugs reacting with each other
What is the purpose of dillent and give an example
Purpose: reduces risk of irritation at injection site
Example: 0.9% sodium chloride
must be compatible for injection
Drug for muscle spasms
Baclofen
Diarhoea
• ORH
• loperamide
Some drugs are inappropriate over the age of 65> such as
Aspirin
Aspirin + peptic ulcer =
Bleeding
CCB and chronic constipation =
Exacerbation of constipation
Diltazem or verapamil + HF =
Exacerbation of HF
BB + verapamil
Heart block
Wafarin - >6 months in DVT ?
No benefit
Wafarin - >12 months in PE ?
No benifit
What is the recommended syringe size for use with syringe driver pump
20ml
