Palliative Care

Question 1

What is the difference between palliative care and end of life care are

Answer 1

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

Question 2

Palliative care - drug stockist scheme?

Answer 2

Provides access to palliative drugs in community pharmacies

But only available to pharmacies who agree to it

Question 3

What resources can be used for symptoms control in palliative care (ie guidance)

Answer 3

• BNF
• palliative care folumary
• palliative care matteres
• the syringe driver
• NEWT
• local guidlines
• NICE
• CKS

Question 4

What is an off label medicine

Answer 4

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)

Question 5

What is a unlicensed drug

Answer 5

A drug which doesn’t have a license for any indication in the uk

Question 6

WHO analgesic - 3 steps

Answer 6

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

Question 7

Common ADRS of opiods

Answer 7

• constipation
• dry mouth
• hallucinations
• headaches
• N&V

Question 8

Why is morphine first line

Answer 8

• a lot of evidence fir its use
• no ceiling affect
• predictable affect
• comes in different form
• wide therapeutic range

Question 9

If there’s renal impairment what would you give

Answer 9

Oxycodone

Question 10

Management of Bone paid

Answer 10

• Radiotherapy
• biphosphanatea
• NSAIDs

Start with the pain ladder - biphosphates as an adjuvant

Question 11

Examples of biphosphonates and when they should be reviewed

Answer 11

• 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

Question 12

What can cause N&V and what is the management

Answer 12

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

Question 13

Pharmacological management of constipation in elderly

Answer 13

Isphagula husk - fybogel

Question 14

Pharmacological management of consumption- if optiod induced

Answer 14

Senna

Elderly - co-danthrustate

Question 15

Pharmacological management of anxiety

Answer 15

• SSRI - fluoxetine
or
• BZD - diazepam

Question 16

Pharmacological management of delirium

Answer 16

Antipsychotic - halperidol

Question 17

Pharmacological management of Agitation

Answer 17

• BZD
or
• antipsychotic - haloperidol

Question 18

If COPD or asthma is the cause of breathlessness what would be the pharmacological management

Answer 18

SABA or SABA + SAMA

Question 19

If underlying cause of can not be fixed, what would you give

Answer 19

Morphine

Question 20

Pharmacological management of respiratory secretions aka death rattle

Answer 20

Antimuscrinics:

• hyoscine butylbromide
• glycopyrronium bromide

Question 21

When are syringe drivers used?

Answer 21

• coma
• bowel obstruction
• persistent nausea & vomiting
• unable to take oral
• multiple and repeated dosing

Question 22

Advantages and disadvantages of of syringe driver

Answer 22

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

Question 23

What needs to be written in a syringe driver prescription:

Answer 23

• doses
• duration of infusion
• dilutent
• end volume of infusion

Question 24

Problems either syringe driver

Answer 24

• over dose
• under dose
• drugs reacting with each other

Question 25

What is the purpose of dillent and give an example

Answer 25

Purpose: reduces risk of irritation at injection site

Example: 0.9% sodium chloride

must be compatible for injection

Question 26

Drug for muscle spasms

Answer 26

Baclofen

Question 27

Diarhoea

Answer 27

• ORH
• loperamide

Question 28

Some drugs are inappropriate over the age of 65> such as

Answer 28

Aspirin

Question 29

Aspirin + peptic ulcer =

Answer 29

Bleeding

Question 30

CCB and chronic constipation =

Answer 30

Exacerbation of constipation

Question 31

Diltazem or verapamil + HF =

Answer 31

Exacerbation of HF

Question 32

BB + verapamil

Answer 32

Heart block

Question 33

Wafarin - >6 months in DVT ?

Answer 33

No benefit

Question 34

Wafarin - >12 months in PE ?

Answer 34

No benifit