Palliative Care 20/7 Flashcards

1
Q

Non-pharmacological management strategies of nausea/vomiting

A
  • Control odours from colostomy, wounds and fungating tumours
  • Minimise sight/smell of food
  • Give small snacks not large meals
  • Try acupressure wrist bands
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2
Q

Pharmacological management of chemical causes of nausea + vomiting e.g. opioids

A

haloperidol
- acts on D2 dopamine receptors
OR metoclopramide
- act on D2 and 5HT receptors

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3
Q

Pharmacological management of gastro causes of nausea+ vomiting e.g. gastric stasis

A

metoclopramide/domperidone

- act on D2 and 5HT receptors

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4
Q

Pharmacological management of non-specific/multi-factorial causes of nausea + vomiting

A

prochlorperazine/levomepromazine

- act on D2, H1 and ACh receptors

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5
Q

Pharmacological management of histaminergic causes of nausea + vomiting

A

cyclizine/promethazine

- act on central and peripheral H1 receptors

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6
Q

Examples of histaminergic causes of N+V

A
  • obstruction
  • peritoneal irritation
  • vestibular causes (motion sickness)
  • raised intra-cranial pressure
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7
Q

Pharmacological management of radio/chemotherapy-induced nausea + vomiting

A

granisetron, ondansetron

- act on 5-HT3-receptors

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8
Q

Pharmacological management of spasmodic causes of nausea + vomiting

A

hyoscine butylbromide (buscopan)

  • antispasmodic that acts on ACh receptors (antimuscarinic)
  • indicated for IBS, bladder cramps and period pain
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9
Q

cough suppressant (antitussive) medications in palliative care

A
  • codeine
  • morphine (COPD/malignancy)
  • glycerol (soothing barrier)
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10
Q

titration options for starting morphine/strong opioid

A
  1. Prescribe the dose on a four hourly as required PRN basis (this relies on the patient asking for pain relief)
  2. Prescribe the dose on a regular basis every four hours (patient receives pain relief without needing to request it)
    For both methods assess the patient’s pain after 24 hours.

If effective change to BD modified relief

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11
Q

breakthrough pain PRN dose

A

1/10th to 1/6th of the equivalent total daily dose of the drug is recommended

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12
Q

opioid adverse effects

A
  • N+V co-prescribe a suitable antiemetic, switch opioid if needed.
  • Constipation co-prescribe a softening and stimulant laxative
  • Cognitive impairment, drowsiness, myoclonic jerks, dysphoria and respiratory depression
  • Urinary retention, may be resolved by dose reduction or opioid switch.
  • Dry mouth
  • Sweating
  • Hallucinations
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13
Q

indications for a syringe driver

A
  • Patient unable to take medication orally
  • Poor absorption of oral medication (N+V, oedema)
  • Intestinal obstruction
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14
Q

syringe driver battery charge required for 24hrs

A

35%

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15
Q

signs of imminent death (palliative)

A
  • increasing frailty
  • difficulty swallowing (last days/hours)
  • withdrawal (more sleeping, confusion in last days)
  • circulatory changes (cold/pale extremities, low BP)
  • breathing changes (Cheyne-Stokes breathing/rattling - last days)
  • sudden event (PE/MI/stroke)
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16
Q

verifying a death

A
  • absence of a carotid pulse over one minute
  • absence of heart sounds over one minute
  • absence of respiratory movements and breath sounds over one minute
  • fixed, dilated pupils (unresponsive to bright lights)
  • no response to a trapezius squeeze
17
Q

sc vs oral morphine dose

A

SC dose is half of PO dose

18
Q

rattle breathing medication

A

glycopyrronium

  • may reduce rattle from secretions
  • not always necessary unless secretions are causing distress
  • 200ug SC up to 6 hourly
19
Q

causes of delirium

A

Pain (and unable to sleep or move around)
Infection (chest, urine, skin etc)
Nutrition
Constipation (or unable to pass urine properly)
Hydration (dehydration and malnutrition)
Medication (sudden stopping or starting drugs)
Environment (being in an unfamiliar place)

20
Q

management of irreversible agitation in palliative

A

Prescribe midazolam 2.5mg SC up to 1 hourly

21
Q

opioid pain relief options in kidney disease

A
oxycodone
fentanyl
buprenorphine
alfentanil esp for syringe driver
methadone
22
Q

examples of bulk-forming laxatives

A

bran

ispaghula husk

23
Q

examples of stimulant laxatives

A

bisacodyl (dulcolax)
senna
docusate sodium (also stool softener)

24
Q

examples of stool softener laxatives

A

docusate sodium

glycerol suppository

25
Q

examples of osmotic laxatives

A
lactulose
macrogol (laxido/movicol)
26
Q

management of short-term constipation

A

bulk-forming laxative eg. ispaghula husk

- add osmotic/stimulant depending on stool

27
Q

management of opioid-induced constipation

A

osmotic and stimulant laxatives

- avoid bulk-forming

28
Q

management of faecal impaction

A

depends on stool consistency
- hard stool = oral macrogol (laxido/movicol)
- soft stool = oral stimulant
enema if unresponsive

29
Q

management of chronic constipation

A

bulk-forming laxative

- add osmotic (eg. macrogol (laxido/movicol))

30
Q

constipation in pregnancy

A

fibre supplements

  • add bulk-forming laxative if required
  • lactulose (osmotic) next if ineffective
31
Q

constipation in children

A

advise increased fibre, exercise and fluid intake

  • macrogol (laxido/movicol)
  • add stimulant if required