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1 Any - Pre-reg Exam > Palliative care > Flashcards

Palliative care Flashcards

1
Q

why is it important that analgesics are given regularly

A

more effective in preventing pain than relieving established pain

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2
Q

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

A

bisphosphonates

strontium isotopes

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3
Q

1st and 2nd line for nueropathic pain?

A 
tricyclic intidepressant (TCA)
antiepileptic (pregab, gabapent)

Other options include ketamine

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4
Q

How to treat neuropathic pain due to nerve compression

A

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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5
Q

frequensy of morphine:
immediate release
modified release

A

immediate 4 hourly

modified 12 hourly

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6
Q

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

A

30 mins

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7
Q

dose for breakthrough pain should be …

how often to reapeat dose?

A

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

2-4 hourly, up to hourly in needed

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8
Q

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

A

2

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9
Q

increments of increase of morphine should not exceed

A

one half to one third of total 24 hour dose

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10
Q

how to transfer patient from immediate release to modified release morphine

A

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

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11
Q

when adjusting morphine do we adjust the dose or the frequency

A

dose

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12
Q

oral to parenteral morphine convertion

A

parenteral is about half oral dose

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13
Q

what is the route of admin of syringe driver

A

SC

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14
Q

why is diamorphine sometimes preferred in syringe driver

A

more soluble

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15
Q

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

A

a third

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16
Q

transdermal route is not suitable for what sort of pain

A

acute and pt who analgesic requirements are variable

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17
Q

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

A

1/4 to 1/2

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18
Q

anorexia symptom control treatment (2)

A

dexamethasone or prednisolone

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19
Q

symptom relief for bowel colic and repiratory recretions

A

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

(4 hourly up to hourly)

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20
Q

symptom treatment - capillary bleeding (3)

A

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

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21
Q

opioid induced constipation in palliative care

A 
PREVENTATIVE
-codanthramer (peristaltic stimulant & fecael softener)
-lactulose and senna
also
-methylnaltrexone
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22
Q

prophylactic treatment for convulsions in palliative care

A

phenytoin or carbamazapine PO

rectal diazepam
phenobarb injection
midazolam syringe driver

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23
Q

dry mouth non pharma treatment

A

sucking ice, chewing gum, sucking pinapple chunks

artificial saliva

24
Q

what to consider as a cause of dry mouth

A 
too much antimuscurinic (e.g. hyoscine)
candida infection (nystatin, miconazole, fluconazole treatment)
25
Q

dysphagia caused by obstruction with tumour could be treated with

A

dexamethasone

26
Q

breathlessness can be relieved with

A

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

27
Q

fungulating tumours treated with

A

dressings

metronidazole systemically for malodour

28
Q

GI pain / colic may be relieved by

A

Loperamide

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

29
Q

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

A

Antacid and antiflatulent and prokinetic before meals

30
Q

Three prokinetic drugs

A

Domperidone,metoclopramide, erythromycin

31
Q

Hiccup may be caused by …. And treated with ….

Also second line ….

A 
Gastric distension.
Preparation incorporating antacid and antiflatulent.
Or if this fails
Metoclopramide 
Baclofen
Nifedipine
32
Q

Insomnia should be treated by

A

Treating the cause eg. Discomfort, cramps.

If this fails BZs could be considered such as temazepam

33
Q

Intractable cough should be treated with ….

And you should NOT treat with …

A

Treat with PO morphine

Don’t treat with methadone because of long duration of action - accumulation,

34
Q

2 treatments for muscle spasm

A

Diazepam or backofen

35
Q

Opioid induced N&V usually only lasts … Days

A

4/5

36
Q

Opioid induced N&V first line (2)

A

Haloperidol and metoclopramide

37
Q

General first line category of antiemetic.?

A

Prokinetic

38
Q

Drugs with ….. Action antagonise prokinetic effect

A

Antimuscurinic

39
Q

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

A

Haloperidol

40
Q

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

A

Metoclopramide

41
Q

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

A

Cyclizine

42
Q

Main treatment for puritus ……

And if it is due to obstructive jaundice also try ….

A

Emollients

Cholestyramine

43
Q

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

A

Dexamethasone … Before 6pm to prevent insomnia

44
Q

Restless and confusion antipsychotic of choice 2

A

Haloperidol and levomepromazine

45
Q

Levomepromazine is also licenced to treat pain in what circumstances

A

Palliative care, unresponsive pain

46
Q

Route of a syringe driver is ….

A

Subcutaneous

47
Q

Three indications for syringe driver

A
  • 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
48
Q

Hyoscine hydrobromide can cause paradoxical ….

A

Agitation

49
Q

Which is more sedative haloperidol or levomeprmazine

A

Levomepromazine

50
Q

Uraemia puts patients another risk of …..

A

Convulsions

51
Q

Problems with putting cyclizine or metoclopramide in a syringe driver

A

Cyclizine - likely to percipitate

Metoclopramide - skin reaction

52
Q

Use of octreotide

A

Stimulates water and electrolyte absorption and inhibits water secretion in the small bowel …

Reduces GI secretions to reduce vomitting due to bowel obstruction

53
Q

Pain control of choice for syringe driver …

A

Diamorphine

54
Q

3 medications that are contraindicated via SC

A

Chlorpromazine
Prochlorperazine
Diazepam

55
Q

Indication for need of change of syringe driver injection site

A

Pain and inflammation.

But not necessarily firmness or swelling

1 Any - Pre-reg Exam (26 decks)

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