Palliative Care

Question 1

Define pain. What does total pain encompass?

Answer 1

An emotional response to actual or potential tissue injury.

Total pain is not just physical Sx:

• mental distress
• social needs
• spiritual needs

Question 2

When do you avoid Targin (oxy/nal).

What should you switch to?

Answer 2

• In Hepatic Dysfunction, naloxone is not metabolised by liver and blocks opioid action centrally.
• Switch to oxycodone (endone)

Question 3

Side effects of opioids

Answer 3

• CONSTIPATION (ALWAYS PRESCRIBE APERIENTS)
• Itch
• Myoclonus
• N/V
• Resp. depression
• confusion -> coma

Question 4

Agents for Neuropathic pain

Answer 4

• AEDs
• TCA’s (anticholinergic SE, toxic in overdose!)
• SNRI (duloxetine SE N/V)

Question 5

DDx for Nausea/vomiting in Pall. Care

Answer 5

• GIT (inc. obstruction)
• Vestibular/central
• infections
• metabolic (high glu, high Ca2, or end organ failure)

Question 6

What are the causes of Malignant hypercalcaemia?

How is it managed?

Answer 6

-Tumour lysis syndrome or paraneoplastic (PTHrp - small cell lung CA or myeloma)

Mx:

• Fluid rehydration (Ca is a diuretic!)
• bisphosphonate OR RANK-L inhibitor (denosumab)

Question 7

Main causes of constipation

Answer 7

Immobility

Diet factors (low fibre/fluid intake)

Meds (opiates, anticholinergics)

Question 8

Management of constipation

Answer 8

Non-pharm (encourage mobility, high fibre/fluid diet)

Aperients -stimulants (senna) softeners (lactulose/movicol) bulking agents (psyllium, coloxyl)

Methylnaloxone - effective as last-line in opioid-induced constipation