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Oncology > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

The indications for corticosteroid

A
  1. Inflammation
  2. Cérébral oedema, metastasis
  3. NV
  4. SC compression
  5. Analgesic (nerve pain)
  6. SOB in COPD exacerbation (reduce anxiety
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2
Q

Conversion bw prednisolone and dexamethasone

A

6mg pred is 1 mg dexathamethasone

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3
Q

Conversion bw buprenophine patch to 24h oral morphine salt

Patch duration

A

Buprenophine 5’ is 12mg PO morphine salt
72h / 96h/ 7d
Given morphine dose /12 then x5

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4
Q

Conversion bw fentanyl patch to PO OD morphine salt

A 
Fentanyl 12’ is 30mg morphine salt OD
25’ is 60mg 
50’ is 120mg 
Available as 72h only 
Given morphine dose/60 then x25
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5
Q

Symptoms for hypercalcaemia

A 
Dehydration 
NV
Constipation 
Confusion 
Cardiac probs
Polydipsia (thirsty)
Pruritus 
Fatigue
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6
Q

Treatment for hyperca

Moa

A 
Rehydration 
Bisphosphonates eg zoledronic acid 
If GFR< 30 ibandronic acid 
Inhibitis osteoclasts activity reduce bone resorption 
reduce ca release
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7
Q

What is Corrected calcium level

A

55% Of calcium in the blood is bound to albumin
45% free ca to be measured
Corrected calcium level takes into account of albumin and protein level

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8
Q

What is the normal range of calcium level

A

2.1-2.6 mmol/L

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9
Q

What are the ranges for hypercalcaemia
Mild
Moderate
Severe

A

2.6-3
3-3.4
>3.4

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10
Q

Treatment for restlessness and agitation

A

Induce sedation
BZ
Midazolam
AP- haloperidol, levomepromazine at high dose

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11
Q

What is death rattle

A

Excessive chest secretion

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12
Q

What are the treatment for secretion

A

Hyoscine butylbromide x BBB, poor BA
Hyoscine hydrobromide yesBBB
Glycopyrrodinium bromide xBBB anti muscarinic
Octreotide somatostatin analogue, reduce gi motility

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13
Q

What is anticipatory medicine what is in that just in case box

A 
medicine given to patient to use at home for emergency symptom control. AM should be based on individual patient’s condition 
Anticipatory medicine for sc use
Needle and syringes
Prescribing guidance
Rx 
PIL
Contact details for advice
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14
Q

What did nice cg31 Care of the dying adult in the last day of life recommend

A
  1. Recognising Last few days of life
  2. Communicate and shared decision-making
  3. Clinically assisted hydration
  4. Meds for Pain,SOB,NV,anxiety,delirium,agitation,secretion
  5. Anticipatory prescribing
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15
Q

What’s the acronym IMPACT stands for in Symptom control of palliative care patient

A 
I Identify concerns
M make an accurate assessment
P Plan your action
A act
C Continuously re-evaluate
T Talk to other HCPS
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16
Q

What did nice guidelines recommend on pain relief for palliative care adult CG140

A

Communication
Start on strong opioid and titrate the dose-oral morphine
Use 1st line maintenance trt
Use transdermal patches if oral opioid not suitable
Use 1st line trt for BT pain in pt who can take oral opioid
Manage constipation.NV. Sedation

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17
Q

What is a typical total daily starting dose of Oral morphine

A

20-30mg OD
10-15mg BD
5mg (1/6-1/10 OD dose)BT

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18
Q 
Inversion between oral morphine with: 
Tramadol/ codeine/ dijudrocodine 
IV morphine 
PO/ IV oxycodone
IV diamorphine 
IV alfentanyl 
PO hydromirphine
A 
X10
/2
/2, /2
/3
/30
/7.5 10mg morphine is 1.3mg hydroM
19
Q

Fentanyl is x times more potent than P.O. morphine?

Why is it used as 2nd line

A

50-100 x more potent
Greater CNS distribution
BUT Not any more effective as analgesic than morphine

20
Q

Treatment for bone pain

A

Bisphosphonates
Zoledronic acid/ pamidronate
If GFR<30 use Ibandronic acid

21
Q

Treatment for neuropathic pain

A 
Antidepressant:  Amitriptyline50mg 
SSRI Fluoxetine
Anticonvulsants:
Sodium valproate 
carbamazepine
Gabapetin 
Ketamine - dysphoria and delirium use BZ or midazolam 
Dexamethasone
22
Q

Mental capacity act 2005 -5 principles

A
  1. A presumption of capacity
  2. Individual supported to make their own decision
  3. Unwise decisions
  4. Best interests
  5. Less restrictive option
23
Q

Impaired Capacity to make decisions according to law

A 
motor neurone disease -30% impaired 
Feeling a burden 
Depression and hopelessness are mutually reinforcing
Major depression 
Medication changes can impair capacity
24
Q

What do u need to make any decision

A

Accurate info
Capacity (decision specific capacity- the capacity you have for making that decision at that time)
Voluntary- Willingness

25
Q

Points covered in Assisted dying proposed legislation to UK Parliament

A 
Terminally ill
Clear and settled wish 
Mental capacity 
Informed of options 
2 doctors
Self administer
26
Q

Why might a patient need a syringe pump

A
  • NV
  • dysphagia can’t swallow tablet
  • pill burden
  • poor GI ab. Eg oleostomy/ stoma/ obstruction
  • profound weakness / unconsciousness
27
Q

Signs of problems with syringe driver

A

Skin irritations
Pain / leaking at injection site
Precipitation in driver
Discolouration of solution

28
Q

How does ph affects diamorphines stability/ solubility

A

Diamorphine less stable, more likely to precipitate if the ph is high >6

29
Q

What is the pH of injectable dexamethasone

What’s the implication and solution

A

Ph 7-9
Strong alkali
It will precipitate our other drugs eg diamorphine
Given as separate bolus inj as long t1/2

30
Q

What are the sources of information for compatibility of syringe driver drugs

A
  • BNF
  • compatibility tables
  • the synringe driver
  • palliative durg.com
  • PCF
  • pallcare guidrlines
31
Q

What are the two benefit of anticipatory prescribing

A

Easy access to care and medicine when needed at home

Helpful when deterioration occurs out of hours

32
Q

When deciding which anticipatory medicines to offer take into account of (NG31)

A
  • likelihood of specific symptoms occurring
  • benefit and harm of rx ing or administering medicine
  • B&H of not rx ing
  • risk of sudden deteriorating for which urgent symptom control may be needed
  • the place of care & time it would take to obtain medicines
33
Q

What are the four main symptoms that are covered in anticipatory medicine

A
  • agitation/ restlessness
  • NV or agitation
  • ex chest secretions
  • pain
34
Q

What are the four main medicines prescribed in anticipatory medicine in just in case box

A

Morphine sulfate - analgesic
Midazolam - anxiolytics sedative
Hyoscine butybromide - anti secretory
Levomepromazine or haloperidol - antiemetic and anxiolytics

35
Q

Treatment for spinal cord compression

What’s the risk

A 
Emergency MRI scan 
16mg dexamethasone IV/PO stat
8mg dexamethasone BD PO ongoing until MRI results 
Stop or wean down asap 
Adrenal suppression
36
Q

What are the main symptom burden is in palliative care

A 
IS PANIC
Immobility
SOB
Pain
Anorexia
NV
Insomnia 
Constipation
37
Q

Nice guidelines on managing side effects of strong opioids

A

Constipation: laxatives + adherence
NV: self résolve + antiemetic
Sedation: self resolve (only initiation/ dose increase) + ability to drive

38
Q

When does patient need opioid rotation

A

Inadequate analgesia despite dose titration and adjuvant

CNS SE remain when dose reduced

39
Q

What are the breakthrough pain alternatives to Liquid Morphine

A

Fentanyl lozenges / SL

ALfentanyl SL/ spray

40
Q

Hydromorphone is X times more potent than P.O. morphine?

A

7.5 x

41
Q

What class of drug is oxycodone

A

Kappa opioid rec agonist - dsyphoria / hallucinations-> midazolam or BZ

42
Q 
What class of drug is methadone 
What is it used for
A

A mixed pharmacology -
Miu agonist
NMDA antagonist (glutamatergic neu trans)
SSRI

Analgesic / opioid addiction / antidepressant

43
Q

What are the characters of methodone

A

Long half life - risk of accumulation

44
Q

In what form is methadone avalible jn

A

Tablet
Liquid
Injection
Suppository

Oncology (7 decks)

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