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CCC > Palliative care > Flashcards

Palliative care Flashcards

1
Q

Patient taking 60mg BD morphine is still getting pain despite taking oromorph for breakthrough pain. How much can you increase his morphine dose by?

A

30-50%. New dose approx 80-90mg BD

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2
Q

What is the maximum dose of morhpine?

A

There isn’t one. Determined by effectiveness and SEs.

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3
Q

Most suitable Tx for liver capsule pain?

A

NSAIDs or corticosteroids. (NSAIDs 1st line unless renal impairment)

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4
Q

Other than analgesia, what Tx is available for bone pain? (2)

A

Radiotherapy.

Bisphosphonates, e.g. pamidronate infusion.

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5
Q

Most appropriate Tx for headaches caused by brain mets?

A

Corticosteroids, e.g. 16mg dexamethasone PO OD - decrease oedema.

Also - NSAIDs, paracetamol

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6
Q

What treatment is available for nerve pain?

A

Antidepressants, e.g. amitriptyline, anticonvulsants e.g. gabapentin

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7
Q

A patient is on PO morphine 60mg BD. What would be the equivalent 24hr SC oxycodone dose?

A

30mg/24hrs (SC = 2x stronger than oral, oxycodone = 2x stronger than morphine)

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8
Q

What is step 1 of the WHO pain ladder?

A

Paracetamol, 1g QDS

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9
Q

Symptoms of opioid toxicity?

A

N/V, myoclonic jerks, drowsy, confused, visual hallucinations, resp depression.

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10
Q

A patient is on PO MST 30mg BD. What would the oromorph PO PRN dose be?

A

10mg, up to 6x daily. (max dose 60mg/24h)

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11
Q

Starting dose of morphine?

A

15-20mg BD

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12
Q

What are the indications for fentanyl patches? (4)

A

Unable to swallow, renal impairment, stable pain, poor oral compliance.

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13
Q

What type of laxative is lactulose? What are the SEs?

A

Stool softener. Bloating & flatulence

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14
Q

Which laxatives are best for opioid-induced constipation?

A

movicol, co-danthrusate/co-danthramer

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15
Q

What steps must you do if a cancer patient develops colic?

A

Stop stimulant laxatives & metoclopramide, give anti-spasmodics, e.g. hyoscine butyl bromide

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16
Q

What is the most appropriate Tx for chemo-induced N&V?

A

Ondansetron

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17
Q

What might be the cause of a patient who is vomiting frequently but only small volumes?

A

Toxic cause - drugs (opioids, digoxin, anti epileptic, RT), hypercalcaemia, uraemia, jaundice infections, renal F

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18
Q

A patient has developed N&V since her renal Cancer recently metastasised to the liver. What drug would you offer her to ease her Sx?

A

Metoclopramide

19
Q

A patient with advanced breast cancer has developed slight nausea & is vomiting on waking. What would be your first plan of action & most likely DDx?

A

Urgent MRI to diagnose any masses or haemorrhage. Tx mass with dexamethasone.

20
Q

Patient receiving chemotherapy for testicular cancer has had progressive SOB over the last few hours. His RR is 24, HR 115, and sats of 94% on air. What is your DDx and possible Ix & Tx?

A

Symptoms of PE. Request D-dimer levels, check if taking an anticoagulant or at high risk of DVT. PE suspected/confirmed - start on AC e.g. tinzaparin.

21
Q

Whilst receiving chemotherapy for colon cancer, a patient has become progressively SOB over the last few weeks. They are also complaining of feeling constantly fatigued. What is a possible cause of these Sx & how would you Tx it?

A

Anaemia secondary to bone marrow suppression from chemo. Tx with transfusion.

22
Q

SOB is caused by an irreversible cause. What Tx can you offer to make the pt more comfortable? (pharm and non-pharm)

A

Fan directed onto face, relaxation techniques, oral opioids (decrease resp effort), BZD to help anxiety/panic.

23
Q

What are the 4 drug classes all patients should be prescribed PRN in palliative care?

A

Analgesics, anti-emetics, anti-secretory, anxiolytic

24
Q

What are the signs of a short prognosis? (Patient entering last few days of life)

A

Profound weakness, drowsy for long periods, disorientated, loss interest in food & drink, too weak to swallow meds

25
Q

What might cause terminal restlessness? (4) How can you treat it?

A

Pain, urinary retention, faecal impaction, respiratory secretions. Look for a potential cause.
Tx with BZD e.g. Midazolam

26
Q

Indications for a syringe driver?

A

Unable to swallow, N&V, intestinal obstruction, malabsorption, dysphagia

27
Q

Examples of anti-secretory drugs? (2)

A

Hyoscine butylbromide (20mg stat or up to 120mg/24h - only available SC), hyoscine hydrobromide

28
Q

What are the characteristics of visceral pain?

A

Dull, deep, poorly localised. Tender over particular area

29
Q

What is a suitable starting dose of morphine? (BD)

A

15-20mg BD

30
Q

What is the maximum dose of co-codamol?

A

2 tablets QDS

31
Q

What do you write in the frequency section of PRN morphine?

A

Hourly - then write the max dose in 24h, e.g. 60mg (if each PRN dose was 10mg)

32
Q

What is the management of oral thrush in a palliative patient?

A

Increase oral fluid intake (if poss, if not IV)

Fluconazole 50mg for 7d, or topical nystatin

33
Q

What questions do you need to ask when talking to a patient with suspected intestinal obstruction?

A

Stool details - diarrhoea, constipation, quantity, frequency, colour, smell
Flatulence - able to pass some?
Abdo pain, distension - colicky pain?

34
Q

What SE should you warn patients of when taking Dantron?

A

Orange urine

35
Q

Most suitable laxative for patient with opioid induced constipation?

A

Mixture laxative - e.g. movicol, co-danthramer, co-danthrusate

36
Q

How would you know whether a patient’s vomiting was due to a gastric or toxic cause?

A

Gastric - big vomits, little nausea between

Toxic - small vomits + retching

37
Q

What are some toxic causes of N+V?

A

Drugs - opioids, digoxin, RT

Hypercalcaemia, uraemia, infections, jaundice

38
Q

A patient is presenting with a constant dull headache, and a recent onset of feeling nauseous with occasional vomiting. You suspect it is due to brain mets. What would you prescribe to manage the Sx?

A

Dexamethasone - 16mg OD

AND… Cyclizine 50mg TDS

39
Q

What might be a cause of sudden SOB in a palliative patient?

A

Asthma, PE, pul oedema

40
Q

How could you manage a patient who has developed SOB over the last few days due to a tumour obstructing their bronchus?

A

Dexamethasone, + stenting

41
Q

What is an important cause to consider in a patient with gradual onset SOB and no other apparent resp/CV Sx?

A

Anaemia - Tx with blood transfusion

42
Q

What non-pharmacological options are available for a patient with irreversible SOB?

A

Discuss fears with family
Direct fan onto face, consider O2
Relaxation techniques, breathing retraining

43
Q

What pharmacological options are available for terminal SOB?

A

Oral opioids - e.g. 2.5mg/4h oramorph

Lorazepam 0.5mg - to ease panic attacks and anxiety

44
Q

When can you not prescribe metoclopramide, haloperidol or domperidone?

A

Parkinsons - risk of EPSEs

CCC (5 decks)

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