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SBOMS > Palliative care > Flashcards

Palliative care Flashcards

1
Q

method of opioid administration in palliative care?

A

Start low and titrate up with regular dose of immediate release and PRN, switching to modified release when pain is controlled.

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2
Q

S/Es of opioids in palliative care?

A
  • N&V - self limiting but metoclopramide/haloperidol useful for anti-emesis
  • Itch - doesn’t respond to anti-histamines as it is CNS
  • Constipation - prophylactic laxatives used
  • Drowsiness - usually self-limiting and for first few days otherwise reduce dose
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3
Q

Opioid toxicity symptoms?

A
  • Myoclonic jerks
  • Agitation
  • Visual hallucinations
  • Confusion
  • Pinpoint pupils
  • Respiratory depression
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4
Q

Management of opioid toxicity?

A
  • Dose reduction
  • Switching opioids
  • Opioid antagonist – naloxone
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5
Q

What opioids are safer for sue in renal failure?

A

Oxycodone and fentanyl

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6
Q

Symptoms of malignant hypercalcaemia?

A

Mild:

  • N&V
  • Anorexia
  • Constipation
  • Thirst and polyuria

Severe:

  • Gross dehydration
  • Drowsiness
  • Confusion & coma
  • Abnormal neurology
  • Arrhythmias
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7
Q

Management of malignant hypercalcaemia?

A

1) Rehydrate with IV 0.9% saline
2) After at least 2L, give bisphosphonate infusion
3) Measure U&Es every day, correcting with IV fluids (Ca normalisation takes 3-5 days)

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8
Q

Options for antiemetics in palliative care?

A

Haloperidol

Cyclizine

Levopromazine

Metaclopramide

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9
Q

Mechanism of action of Haloperidol, and uses?

A

Dopamine antagonist - acts at the CTZ

Best used for chemical causes, e.g. drugs, renal failure, hypercalcaemia

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10
Q

Mechanism of action of Cyclizine, and uses?

A

Antihistamine and anticholinergic with acts at the vomiting centre

Used in complete bowel obstruction, raised ICP, motion sickness

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11
Q

Mechanism of action of Metaclopramide, and uses?

A

Peripheral DA antagonist and 5HT4 agonist, and a central 5HT3 antagonist

Helps to control acid reflux (prokinetic)

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12
Q

Mechanism of Levopromazine, and uses

A

Acts at multiple receptors

  • many S/Es, broad spectrum
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13
Q

Causes of bowel obstruction in palliative care patient?

A

Extrinsic compression e.g primary tumour, omental masses, malignant adhesions, fibrosis

Intraluminal occlusion from tumour

Motility disorders (tumour infiltrating muscle)

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14
Q

Management of complete bowel obstruction in the palliative care patient?

A
  • Pain control
  • Improve motility (laxatives, maybe steroids or prokinetics)
  • Anti-emetics
  • Reduce colic if present
  • Reduce gastric secretions (anticholinergic/somatostatin analogue)
  • NG tube (often last resort in palliation)
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15
Q

Antispasmodic antisecretory agents?

A

Hyoscine butylbromide (Buscopan) – Ach antagonist

Octreotide = somatostatin analogue

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16
Q

Palliative surgical procedures for bowel obstruction?

A
  • Venting gastrostomy (tube from stomach to outside of abdomen)
  • Duodenal/rectal stent
  • Surgical palliative bypass
17
Q

When might you use continuous subcutaneous infusions in palliative care?

A
  • Intractable vomiting (treatment resistant)
  • Severe dysphagia
  • Poor GI absorption
  • Too weak to swallow oral medications
18
Q

Metastases that can compress the spinal cord?

A
  • Lung
  • Breast
  • Prostate
  • Kidney
  • Melanoma
  • Multiple myeloma
  • Lymphoma
19
Q

Regions of the spinal cord that can be compressed?

A
  • Cervical (breast)
  • Thoracic (lung, breast, prostate)
  • Lumbosacral (GI, prostate)
  • Below L1/L2 = cauda equina syndrome
20
Q

Signs and Symptoms of spinal cord compression?

A

Symptoms:

  • Back pain (often band-like)
  • Tingling and numbness – often starts in feet and goes
  • Myelopathy – rapid onset
  • Bladder/bowel symptoms are typically late and so indicate poor prognosis

Signs:

  • Sensory change (possibly with a level)
  • Hypo/hyperreflexia
  • Weakness
  • Perianal sensory changes/loss of sphincter tone
21
Q

Management of spinal cord compression?

A
  • High dose dexamethasone (2 separate 16mg doses)
  • Radiotherapy and/or surgery
  • MDR approach to rehab
22
Q

Management of neuropathic pain?

A
  • TCAs e.g. amitriptyline
  • Anticonvulsants e.g. gabapentin
  • Steroids e.g. dexamethasone
23
Q

What is total pain, what aspects make up total pain?

A

All the pain a patient may be experiencing, including:

Physical pain
Social pain
Pyschological pain
Spiritual pain

24
Q

Common causes of vomiting?

A

Mouth and pharynx - Taste, secretions, candida

GI - stasis, obstruction, gastritis, constipation

Drugs

Metabolic e.g. hypercalcaemia

Toxic, infection

Raised ICP

Balance

Anxiety/fear

25
Q

Compression below the level of L1/2 is called what?

A

Cauda equina syndrome

26
Q

Most common level of spinal cord compression?

A

Thoracic

SBOMS (18 decks)

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