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4th year block 4 > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

Which antiemetic would be effective for opioid induced nausea

A

Opiates cause gastric stasis - Domperidone/metoclopramide

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2
Q

Name the appropriate first line antiemetic used for hypercalcaemia or other biochemical imbalances

A

Haloperidol

Could also use domperidone or metoclopramide

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3
Q

First line antiemetic to be used during chemotherapy

A

Ondansetron

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4
Q

Symptoms of bowel obstruction

A

large volume and frequently offensive (faeculent)

increasing abdominal pain

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5
Q

Antiemetic to be used when patient has inoperable bowel obstruction
any further management?

A 
Trial of cyclizine and/or haloperidol 
Buscopan for bowel colic 
Anti-secretory octeotide 
Trial of steroids may reduce obstruction/inflammation
May need venting gastrostomy tube
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6
Q

Treatment for anticipatory nausea

A

Lorazepam

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7
Q

Treatment for squashed stomach syndrome

A

Prokinetic anti-emetic e.g. metoclopramide and an anti-foaming antacid
Consider a trial of steroids

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8
Q

Squashed stomach syndrome

A

Early satiety
Delayed gastric emptying (functional e.g. opioids; anatomical e.g. stomach outflow obstruct)
Hepatomegaly and ascites

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9
Q

Treatment for someone with cerebral metastases where headache is not a problem but nausea and vomiting (associated with dizziness) on movement have become major problems

A

Cyclizine

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10
Q

Drug therapy for nausea with an unknown cause or not responding to other measures (multifactorial)

A

Levomepromazine - is an anti-psychotic and is very potent anti-emetic
Used in anticipatory prescribing

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11
Q

Drugs associated with nausea and vomiting

A 
Opioids
Syrupy sweet liquids e.g. lactulose
NSAID
Antibiotics
Anti-depressants and anti-epileptics
Digoxin
Alcohol 
Chemotherapy
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12
Q

Metabolic causes of nausea/vomiting

A 
Hypercalcaemia
Uraemia
Hyponatraemia 
Ketoacidosis
Infection
Addison's disease
Pregnancy
Tumour or bacterial toxins
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13
Q

Non-drug approaches to management of breathlessness

A
  • Exploring the perception of patient and carer
  • Maximise feeling of control over breathlessness (anxiety management, relaxation, use a fan)
  • Maximise functional activity (energy preservation, increase exercise tolerance)
  • Environment (ventilation, tobacco smoke, energy preservation, anxiety triggers)
  • Reduce feelings of personal and social isolation (meeting others at day care)
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14
Q

Treatment of superior vena caval obstruction

A

oxygen
high dose steroids
stent
radiotherapy or chemo if sensitive cancer

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15
Q

Lymphangitis carcinomatosis

A

Diffuse infiltration of lymphatics of lungs by cancer cells

commonly secondary to adenocarcinoma

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16
Q

Symptoms of lymphangitis carcinomatosis

A

SOB, pleuritic chest pain and cough

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17
Q

Prognosis for lymphangitis carcinomatosis

A

poor - median survival 3 months

18
Q

Cancers which cause lymphangitis carcinomatosis

A 
Certain - cervix
Cancers - colon
Spread - stomach
By - breast 
Plugging - pancreas
The - thyroid 
Lymphatics - larynx
19
Q

What causes a death rattle

A

accumulating saliva +/- sputum in airways as patient unable to swallow

20
Q

Prevention/treatment of a death rattle

A

Hyoscine butylbromide - anticholinergic dries up saliva/secretions

21
Q

Describe Cheyne-Stokes respiration

A

periods of apnoea then really fast then slow, slow, slow then apnoea again - patient is unaware

22
Q

symptoms of opioid toxicity

A 
Myoclonic jerks - if not picked up will lead to seizure 
Respiratory depression
Hallucinations and/or vivid dreams
Confusion and/or agitation
(pinpoint pupils/miosis)
23
Q

Opioid side effects

A 
Drowsiness
Constipation
Nausea
Dry mouth 
(miosis/pinpoint pupils)
24
Q

categories of pain

A

Nociceptive - somatic or visceral

Neuropathic

25
Q

Describe somatic pain

A

Aching often constant pain which may may be dull or sharp, is well localised and often worse with movement e.g. bone and soft tissue

26
Q

Neuropathic pain symptoms

A

severe, parasthesia, burning, shooting, electric shock caused by traumatic or ischaemic injury to PNS

27
Q

How does subcutaneous morphine compare with oral

A

SubCut is 2x as potent as oral

28
Q

How do you work out what dose to give for breakthrough meds

A

1/6 of dose taken in a 24 hours

29
Q

If you cough or strain and get shooting pains down your back what are you at risk of

A

Cord compression

30
Q

what is incident pain

A

Pain on movement - common with bony metastasis

Advise to take breakthrough meds before they move

31
Q

Hyperalgesia compared with allodynia

A

Hyperalgesia is when a painful stimulus is more painful

Allodynia is when non-painful stimuli are painful

32
Q

How long can you use steroids before being concerned about adrenal insufficiency when taking them off

A

no more than 4 weeks

33
Q

Possible adjuvants for opiate therapy used for general/non-specific pain

A

Corticosteroids

34
Q

Describe visceral pain

A

Constant or crampy pain, aching, poorly localised, referred

e.g. Ca pancreas, liver capsule distension, bowel obstruction

35
Q

Indications for dexamethasone

A

Decrease inflam, oedema, tumour mass effects

– raised ICP, liver capsule, nerve or cord compression

36
Q

Adjuvants used for neuropathic pain alongside opiates

A 
Gabapentin, pregabalin
Antidepressants, tricyclics
Ketamine
Clobazam
Lidocaine 5% patch
37
Q

Adjuvants used for bone pain alongside opiates

A

Bisphosphonates

38
Q

Non-pharmacological management of pain

A 
Acupuncture
CBT
Meditation/relaxation 
TENS
Therapeutic massage 
Radiotherapy 
Interventional techniques
39
Q

Name the 4 anticipatory meds and their 5 indication

A

MORPHINE - breathlessness
MIDAZOLAM - anxiety
LEVOMEPROMAZINE - nausea
BUSCOPAN - secretions and colic

40
Q

Treatment for terminal agitation

A

Stop benzos

Use levomepromazine in higher dose than for nausea

4th year block 4 (1 decks)

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