Palliative care

Question 1

what are the principles of palliative care

Answer 1

improve qol for patients and their families with a life threatening illness
through prevention and relief of suffering, early identification, impeccable assessment, treatment of pain and other problems

physical, psychosocial and spiritual

Question 2

what does approaching the end of life

Answer 2

likely to die within 12 months

those facing imminent death and those with advanced, progressive, incurable conditions, general frailty
at risk of sudden death
life threatening conditions caused by sudden catastrophic events

Question 3

what are the key themes for development

Answer 3

early identification of patients who may need palliation

advanced anticipatory care planning

care in last hours/days

delivery of effective and timely care

Question 4

what structures have replaced the Liverpool care pathway

Answer 4

One chance to get it right

care for people in the last days and hours of life

Question 5

what are the principles of good end of life care

Answer 5

open lines of communication 
anticipation care needs
encouraging discussion 
effective MDT input
symptom control 
preparing for death 
providing support for relatives before and after

Question 6

what is generalist palliative care

Answer 6

part of routine care delivered by all health and social care professionals, at home, in care or in a hospital

Question 7

what is specialist palliative care

Answer 7

can help people with more complex palliative care needs

Question 8

what are some features of pain

Answer 8

can be multifactorial
more than one pain
background/ breakthrough/ incident pain
many causes

Question 9

what are the features of bone pain

Answer 9

worse on pressure/ weight bearing

Question 10

what are the features of liver pain

Answer 10

RIQ tenderness

Question 11

what are the features of raised ICP

Answer 11

headache, worse lying down and in the morning

Question 12

what is colic

Answer 12

intermittent cramping pain

Question 13

what is neuropathic pain

Answer 13

Burning/shooting/tingling/jagging/altered

sensation

Question 14

name some weak opioids

Answer 14

codeine, tramadol, dihydrocodeine

Question 15

name some strong opioids

Answer 15

morphine, diamorphine, fentanyl, oxycodone

Question 16

what does by the clock pain relief mean

Answer 16

analgesics should be given at regular intervals

Question 17

what are some cautions for opioids

Answer 17

renal impairment, acute respiratory depression, elderly

however for terminal illness these should not necessarily rule out use of opioids

Question 18

what are the most common side effects of opioids

Answer 18

nausea, vomiting, constipation, dry mouth, biliary spasm

opioid toxicity

Question 19

what are the features of opioid toxicity

Answer 19

– Shadows edge of visual field
– Increasing drowsiness
– Vivid dreams / hallucinations
– Muscle twitching / myoclonus
– Confusion
– Pin point pupils
– Rarely, respiratory depression

Question 20

what are the features of practical prescribing for morphine

Answer 20

controlled release for background pain relief
twice a day

also breakthrough pain relief as required

Question 21

what must be prescribed for constipation during opioid use

Answer 21

stimulant and softening laxative
senna, bisacodyl, docusate
etc

Question 22

what antiemetics can be prescribed for nausea associated with opioids

Answer 22

metoclopramide
haloperidol (consider QT interval)

Question 23

what can be prescribed for neuropathic pain

Answer 23

Amitriptyline/ Gabapentin/ Carbamazepine

Question 24

what can be prescribed for liver capsule pain/ raised ICP

Answer 24

Steroids (dexamethasone)

Question 25

what can be given for bowel/bladder spasms

Answer 25

buscopan (hyoscine butyl bromide)

Question 26

why are smaller volumes of diamorphine needed

Answer 26

more water soluble than morphine

Question 27

what is oxycodone

Answer 27

second line opioid

less hallucinations, itch, drowsiness, confusion

Question 28

what is fentanyl patch

Answer 28

second line opioid
lasts 72 hours
use in stable pain 
use if oral/SC routes unavailable 
useful if persistant side effects with first line opioids