Palliative Care Flashcards
What does palliative care focus on?
QoL of patients and their families
Prevention and relief of suffering
Physical/psychosocial/spiritual problems
What proportion of patients die during their admission to hospital?
1/10
Name 5 symptoms that need to be controlled in end of life care
Fatigue Pruritis Dyspnoea Pain Muscle cramps
What affects pain?
Physical
Psychological (fear, anxiety, anger)
Social (carer strain, fear)
Spiritual (anguish, suffering, hopelessness)
What is the WHO pain ladder?
The steps taken as pain worsens
Start with non opioid +/- adjuvants (paracetamol, NSAIDs)
Progress to mild opioid +/- non opioid +/- adjuvant
Then to strong opioid
What does PRN mean?
As needed (pro re nata)
Dosing of opioids
Regular doses of immediate release opioid + PRN 1/6 of total
SE of opioids?
Nausea, vomiting, constipation, sweat, itch
6 signs of opioid toxicity
Myoclonic jerks Agitation Visual hallucinations Confusion Pin point pupils Respiratory depression (late)
How do you deal with opioid toxicity?
Due to problems in renal excretion/liver metabolism?
Switch to different opioid?
Opioid antagonist (naloxone)
Fentanyl patches
What opioid is best for renal insufficiency?
Oxycodone
What is the most common life threatening metabolic disorder encountered in patients with cancer?
Hypercalcaemia
8 signs/symptoms of hypercalcaemia
Nausea and vomiting Anorexia Constipation Feeling thirsty Polyuria Drowsy, confused Coma Cardiac arrythmias Abnormal neurology
How do you manage hypercalcaemia?
Rehydration
Bisphosphonate infusion (pamidronate)
(Takes 3-5days)
What pattern of nausea and vomiting does someone experience in bowel obstruction?
Little nausea, large volume vomit, better after vomit
What pattern of nausea and vomiting does someone experience in drug induced n&v
Constant nausea, little vomit, no relief after vomit
What causes nausea?
Taste, candida, secretions Bowel stasis, gastritis, constipation, obstruction Drugs Hypercalcaemia/uraemia Infection Increased ICP Motion sickness Fear, smell association
What receptors does the vomiting centre have?
H1 (Histamine)
Muscarinic
5HT2 (serotonin)
What receptors does the inner ear have?
Histamine
Muscarinic
What receptors does the CTZ have?
D2 (dopamine)
5HT3 (serotonin)
NK1 (neurokinin)
What receptors does the gut have?
5HT3 (serotonin)
CB1 (cannabinoid)
NK1 (neurokinin)
What commonly causes bowel obstruction in palliative patients
Extrinsic compression Omental masses Post irradiation fibrosis 1º tumour in bowel Infiltration into mesentery/muscle -> peristalsis affected
Signs and symptoms of complete bowel obstruction
Colicy pain Distended abdomen No bowel action for a while No flatus Large volume faecalent vomits
Palliative treatment for bowel obstruction
Pain control
Anti emetics
Anticholinergics (decrease secretions)
Somatostatin analogues (decrease secretions)
Laxatives (improve gut motility)
NG tube as last resort]Stents/bypass surgery can be of benefit
Venting gastrostomy
Name 3 antiemetics
Cyclizine
Levomapromazine
Metochlopramide
Name 2 antipasmodics
Hysocine butybromide
Octreotide
5 symptoms of spinal cord compression
Back pain Parasthesia Muscle weakness Incontinence Sensory changes
What level does spinal cord compression become cauda equina syndrome?
L1/L2
Treatment of spinal cord compression?
High does steroid, radiotherapy+/- surgery
What causes neuropathic pain
Pressure/destruction of peripheral, autonomic or central nervous system
Name 3 treatments for neuropathic pain
Gabapentin
Dexamethasone
Amitriptyline
