Palliative Care Flashcards
What is the first line pain management in palliative care
Give examples
Non-opioid
Paracetamol
NSAIDs
What is the second line pain management in palliative care
Give examples
Opioids
E.g. codeine and morphine
What adjuvants are used in pain management in palliative care
Give examples
Anti epileptics - gabapentin
Antidepressants - amitriptylline
What tool is used to decide what pain medication should be used in cancer care
WHO analgesic ladder
What type of pain medication is used for cancer pain
Strong opioids
What is the first line for cancer pain
Morphine oral MR and IR morphine for breakthrough pain
Is morphine is not tolerated and a patient has cancer pain what 4 alternatives can be used ?
Oxycodone
Fentanyl
Buprenorphine
Hydromorphone
What is required when administering morphine/ strong opioids for cancer pain
Regular monitoring of pain and side effects
What side effects are associated with laxatives and how can they be reduced/solved?
Respiratory depression
Nausea/vomitting - give antiemetic
Constipation - laxatives [avoid bulk forming]
What is the most common cause of dysphasia in pallative care
Oesophagitis
What medication is given to treat dysphasia
Dexamethasone
What is the medication used to treat dysphasia caused by oesophagitis
Sublingual glyceryl trinitrate before meals
What 3 drug classes cause dry mouth
Antidepressants
Antiemetics
Antimuscarinics
How do you treat dry mouth [there are 5 things]
Artificial saliva
Sucking ice chips
Good mouth care
Frequently sipping water
Chewing sugar free gum
What medication used to treat hiccups is pro kinetic
Metoclopramide
What medications used to treat hiccups are antiflatulents [2]
Simeticone
Peppermint oil
What 5 drugs are used for hiccups
Lansoprazole
Omeprazole
Simethicone
Peppermint oil
Metoclopramide
What is used to treat an intractable dry cough ? And give examples
Demulcents
E.g. simple linctus and morphine
What is used to treat an intractable cough with sticky sputum ? And give examples
EXPECTORANTS
E.g. nebulised NaCl
MUCROLYTICS
E.g. Acetylcysteine
First line for constipation in palliative care
Stimulant laxatives such as Senna
2nd line for constipation in palliative care
Osmotic laxative such as lactulose
Which laxatives should be avoided in patients in palliative care with constipation? And why
Bulk forming laxatives
Can cause intestinal obstruction
What is used to treat bowel colic
Hyoscine butylbromide
What is used to treat colic in palliative care
Docusate sodium suppositories or enemas
What is used for unresponsive opioid induced constipation
Methylnaltrexone
What medication can cause insomnia
[2]
Corticosteroids
Diuretics
What 5 conditions can cause insomnia in palliative care patients
Pain
Depression
Anxiety
Delirium
Obstructive sleep apnoea
What 5 medication groups are used to treat insomnia in palliative care patients
Give examples of each
Benzodiazepines - Midazolam
Z drugs - Zolpidem
Antidepressants - Doxepin, Trazadone
Antipsychotics - Olanzapine
Melatonin
What is used to treat agitation with anxiety
Benzodiazepines
What is used to treat agitation and delirium
Haloperidol
What medication is used to treat anxiety that has lasted/lasts months
SSRI without BZP
What 2 medications are used to treat anxiety that lasts for weeks-months
Diazepam
Lorazepam
Non pharmacological treatment for anxiety
CBT
What is the first line pharmacological treatment for breathlessness in palliative care patients
Trial of bronchodilators
What is the pharmacological treatment for advanced breathlessness in palliative care patients
Low dose morphine
What are the pharmacological treatments for anxiety induced breathlessness in palliative care patients
There are 3
SSRI
Benzodiazepines
Corticosteroids
What non pharmacological interventions/advice can be given/advised for breathlessness
There are 4
Using a fan
Breathing technology
Relaxation
Positioning [slight elevation]
What is the first line treatment of seizures for patients in palliative care
Levetiracetam
What seizure medication is used in the last days of life
Midazolam
What is anticipatory prescribing
Prescribing that ensures that patients with advancing illness and uncontrolled symptoms have timely access to medication
What antiemetic is given in anticipatory prescribing
Levomepromazine subcutaneous injection 2.5-5mg
What antisecretory is given in anticipatory prescribing
Hyoscine butylbromide injection 20mg [buscopan]
What medication is given for pain and breathlessness in anticipatory prescribing
10 ampoules of morphine sulphate injection 2.5mg/hr
What anxiety/agitation/breathlessness is given for pain and breathlessness in anticipatory prescribing
Not terminal patients
Sedative anxiolytics e.g. Midazolam injection
What anxiety/agitation/breathlessness is given for pain and breathlessness in anticipatory prescribing
For terminal patients
Terminal agitation and delirium
Levomepromazine
what is palliative care
Interdisciplinary approach designed to improve the QOL for patients with serious, chronic or life-threatening illnesses
Goal of palliative care
Symptom management
Psychological, social and spiritual support
What is end of life care
Specialised palliative care provided in the final phase of a patients life
Goal of end of life care
Focuses on comfort, dignity and support as the patient approaches death
It must respect a persons wishes
Provides support to family
What is deprescribing
Safely withdrawing medication that is no longer beneficial or wanted in agreement with patient or family/carer
