Palliative care Flashcards by Leafy Charlton

why is it important that analgesics are given regularly

more effective in preventing pain than relieving established pain

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what can be used to control the pain of bone mets? (2)

bisphosphonates

strontium isotopes

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1st and 2nd line for nueropathic pain?

tricyclic intidepressant (TCA)
antiepileptic (pregab, gabapent)

Other options include ketamine

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How to treat neuropathic pain due to nerve compression

corticosteroid such as dexamethasone (reduces oedema around the tumour)

Also consider nerve blocks & regional anesthesia (e.g. epidural) if pain is localised

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frequensy of morphine:
immediate release
modified release

immediate 4 hourly

modified 12 hourly

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how long before an activity that causes pain should a breakthrough pain dose be given

30 mins

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dose for breakthrough pain should be …

how often to reapeat dose?

1/10 to 1/6 of total 24 hour dose

2-4 hourly, up to hourly in needed

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if they need breakthrough dose. ……. times a day the regular dose should be reviewed

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increments of increase of morphine should not exceed

one half to one third of total 24 hour dose

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how to transfer patient from immediate release to modified release morphine

four hours after immediate release dose give the modified release dose (with same 24 hour total dose)

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when adjusting morphine do we adjust the dose or the frequency

dose

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oral to parenteral morphine convertion

parenteral is about half oral dose

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what is the route of admin of syringe driver

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why is diamorphine sometimes preferred in syringe driver

more soluble

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equlvilent S/C dose of diamorphine is about ……. of the dose of oral morphine

a third

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transdermal route is not suitable for what sort of pain

acute and pt who analgesic requirements are variable

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when switching to transdermal patch due to opioid induced hyperanalgesia how much should the dose be reduced by?

1/4 to 1/2

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anorexia symptom control treatment (2)

dexamethasone or prednisolone

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symptom relief for bowel colic and repiratory recretions

S/c hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium (antimuscurinics)

(4 hourly up to hourly)

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symptom treatment - capillary bleeding (3)

tranxeamic acid PO
or tranexamic acid or adrenaline solution soaked gauze to affected area
vit k ( for liver disease)

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opioid induced constipation in palliative care

PREVENTATIVE
-codanthramer (peristaltic stimulant &amp; fecael softener)
-lactulose and senna
also
-methylnaltrexone

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prophylactic treatment for convulsions in palliative care

phenytoin or carbamazapine PO

rectal diazepam
phenobarb injection
midazolam syringe driver

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dry mouth non pharma treatment

sucking ice, chewing gum, sucking pinapple chunks

artificial saliva

what to consider as a cause of dry mouth

too much antimuscurinic (e.g. hyoscine)
candida infection (nystatin, miconazole, fluconazole treatment)

dysphagia caused by obstruction with tumour could be treated with

dexamethasone

breathlessness can be relieved with

PO morphine diazepam if due to anxiety corticosteroid if bronchospasm/obstruction

fungulating tumours treated with

dressings | metronidazole systemically for malodour

GI pain / colic may be relieved by

Loperamide | Also hyoscine hydrobromide sc/IV, hyoscine butyl bromide, glycopyrronium

Abdominal distension due to pressure on the stomach may be relieved by .... And ....

Antacid and antiflatulent and prokinetic before meals

Three prokinetic drugs

Domperidone,metoclopramide, erythromycin

Hiccup may be caused by .... And treated with .... Also second line ....

``` Gastric distension. Preparation incorporating antacid and antiflatulent. Or if this fails Metoclopramide Baclofen Nifedipine ```

Insomnia should be treated by

Treating the cause eg. Discomfort, cramps. If this fails BZs could be considered such as temazepam

Intractable cough should be treated with .... | And you should NOT treat with ...

Treat with PO morphine | Don't treat with methadone because of long duration of action - accumulation,

2 treatments for muscle spasm

Diazepam or backofen

Opioid induced N&V usually only lasts ... Days

4/5

Opioid induced N&V first line (2)

Haloperidol and metoclopramide

General first line category of antiemetic.?

Prokinetic

Drugs with ..... Action antagonise prokinetic effect

Antimuscurinic

What is used for metabolic causes of nausea eg. Renal failure , hypercalcemia

Haloperidol

What is used for nausea associated with gastritis, gastric statis and functional bowel obstruction

Metoclopramide

Treatment for nausea due to increase intracranial pressure, motion sickness and mechanical bowel obstruction

Cyclizine

Main treatment for puritus ...... | And if it is due to obstructive jaundice also try ....

Emollients | Cholestyramine

Headache due to raised intracranial pressure can be treated with .....

Dexamethasone ... Before 6pm to prevent insomnia

Restless and confusion antipsychotic of choice 2

Haloperidol and levomepromazine

Levomepromazine is also licenced to treat pain in what circumstances

Palliative care, unresponsive pain

Route of a syringe driver is ....

Subcutaneous

Three indications for syringe driver

- unable to take medication by mouth - does not wish to take meds by mouth - in malignant bowel obstruction to avoid insertion of NG tube or IV admin

Hyoscine hydrobromide can cause paradoxical ....

Agitation

Which is more sedative haloperidol or levomeprmazine

Levomepromazine

Uraemia puts patients another risk of .....

Convulsions

Problems with putting cyclizine or metoclopramide in a syringe driver

Cyclizine - likely to percipitate | Metoclopramide - skin reaction

Use of octreotide

Stimulates water and electrolyte absorption and inhibits water secretion in the small bowel ... Reduces GI secretions to reduce vomitting due to bowel obstruction

Pain control of choice for syringe driver ...

Diamorphine

3 medications that are contraindicated via SC

Chlorpromazine Prochlorperazine Diazepam

Indication for need of change of syringe driver injection site

Pain and inflammation. | But not necessarily firmness or swelling