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SBOMs > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

What does palliative care focus on?

A

QoL of patients and their families
Prevention and relief of suffering
Physical/psychosocial/spiritual problems

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2
Q

What proportion of patients die during their admission to hospital?

A

1/10

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3
Q

Name 5 symptoms that need to be controlled in end of life care

A 
Fatigue
Pruritis
Dyspnoea
Pain
Muscle cramps
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4
Q

What affects pain?

A

Physical
Psychological (fear, anxiety, anger)
Social (carer strain, fear)
Spiritual (anguish, suffering, hopelessness)

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5
Q

What is the WHO pain ladder?

A

The steps taken as pain worsens
Start with non opioid +/- adjuvants (paracetamol, NSAIDs)
Progress to mild opioid +/- non opioid +/- adjuvant
Then to strong opioid

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6
Q

What does PRN mean?

A

As needed (pro re nata)

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7
Q

Dosing of opioids

A

Regular doses of immediate release opioid + PRN 1/6 of total

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8
Q

SE of opioids?

A

Nausea, vomiting, constipation, sweat, itch

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9
Q

6 signs of opioid toxicity

A 
Myoclonic jerks
Agitation
Visual hallucinations
Confusion
Pin point pupils
Respiratory depression (late)
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10
Q

How do you deal with opioid toxicity?

A

Due to problems in renal excretion/liver metabolism?
Switch to different opioid?
Opioid antagonist (naloxone)
Fentanyl patches

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11
Q

What opioid is best for renal insufficiency?

A

Oxycodone

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12
Q

What is the most common life threatening metabolic disorder encountered in patients with cancer?

A

Hypercalcaemia

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13
Q

8 signs/symptoms of hypercalcaemia

A 
Nausea and vomiting
Anorexia
Constipation
Feeling thirsty
Polyuria
Drowsy, confused
Coma
Cardiac arrythmias
Abnormal neurology
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14
Q

How do you manage hypercalcaemia?

A

Rehydration
Bisphosphonate infusion (pamidronate)
(Takes 3-5days)

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15
Q

What pattern of nausea and vomiting does someone experience in bowel obstruction?

A

Little nausea, large volume vomit, better after vomit

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16
Q

What pattern of nausea and vomiting does someone experience in drug induced n&v

A

Constant nausea, little vomit, no relief after vomit

17
Q

What causes nausea?

A 
Taste, candida, secretions
Bowel stasis, gastritis, constipation, obstruction
Drugs
Hypercalcaemia/uraemia
Infection
Increased ICP 
Motion sickness
Fear, smell association
18
Q

What receptors does the vomiting centre have?

A

H1 (Histamine)
Muscarinic
5HT2 (serotonin)

19
Q

What receptors does the inner ear have?

A

Histamine

Muscarinic

20
Q

What receptors does the CTZ have?

A

D2 (dopamine)
5HT3 (serotonin)
NK1 (neurokinin)

21
Q

What receptors does the gut have?

A

5HT3 (serotonin)
CB1 (cannabinoid)
NK1 (neurokinin)

22
Q

What commonly causes bowel obstruction in palliative patients

A 
Extrinsic compression
Omental masses
Post irradiation fibrosis
1º tumour in bowel
Infiltration into mesentery/muscle -> peristalsis affected
23
Q

Signs and symptoms of complete bowel obstruction

A 
Colicy pain
Distended abdomen
No bowel action for a while
No flatus
Large volume faecalent vomits
24
Q

Palliative treatment for bowel obstruction

A

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

25
Q

Name 3 antiemetics

A

Cyclizine
Levomapromazine
Metochlopramide

26
Q

Name 2 antipasmodics

A

Hysocine butybromide

Octreotide

27
Q

5 symptoms of spinal cord compression

A 
Back pain
Parasthesia
Muscle weakness
Incontinence
Sensory changes
28
Q

What level does spinal cord compression become cauda equina syndrome?

A

L1/L2

29
Q

Treatment of spinal cord compression?

A

High does steroid, radiotherapy+/- surgery

30
Q

What causes neuropathic pain

A

Pressure/destruction of peripheral, autonomic or central nervous system

31
Q

Name 3 treatments for neuropathic pain

A

Gabapentin
Dexamethasone
Amitriptyline

SBOMs (18 decks)

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