Palliative care Flashcards

1
Q

Chemoreceptor trigger zone situated where

A

postrema on the floor of 4th ventricle

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2
Q

Vomiting centre situated where

A

Close to CTZ, in medulla

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3
Q

With regards to BBB where are CTZ/ vomiting centre are

A

Inside BBB ; VOMITING CENTRE

Outside BBB: CTZ

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4
Q

Vomiting centre role

A

Collection of motor nuclei

Coordinates emetic process

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5
Q

Antiemetics for peripheral cause of nausea/vomitting

A

prokinetics

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6
Q

Prokinetics eg

A

Domperidone

Metoclopramide

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7
Q

Antiemetics for CTZ centrally caused nausea and vomiting

A

D2 antagonist

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8
Q

D2 antagonist eg

A

Haloperidol

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9
Q

Antiemetics for other centrally caused nause and vomiting

A

H1 antagonist

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10
Q

H1 antagonist eg

A

cyclizine

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11
Q

Levomepromazine

A

Broad spectrum antiemetic

antagnoist at 5HT2, H1, A1

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12
Q

Granisetron

A

anti emetic 2nd line

5HT3 antagonist

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13
Q

Aprepitant

A

antiemetic 2nd line

neurokinin receptor antagonist

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14
Q

Nabilone

A

2nd line antiemetic

cannabinoid (specialist use only)

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15
Q

Laxative classes

A

Softner

Stimulant

Osmotic

Bulk forming

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16
Q

Softner eg

A

docusate

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17
Q

Stimulant eg

A

Senna

Bisacodyl

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18
Q

Osmotic eg

A

Movicol

Laxido

Lactulose

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19
Q

Bulk forming eg

A

Fybogel

20
Q

Opiod induced constipation rx eg

A

Methylnaltrexone injection,

naloxegol

21
Q

Glycerine

A

softening suppository

22
Q

Bisacodyl

A

Stimulant suppository

23
Q

Micralax

A

combined suppository

24
Q

Arachas oil

A

softening enema

25
Q

Phosphate

A

stimulant enema

26
Q

Rx of diarrhoea

A

Loperamide

Opioids

Hyoscine butylbromide

Octreotide

Creon (steatorrhoea)

27
Q

Xerostomia

A

dry mouth

28
Q

Xerostomia mx

A

saliva substitute

saliva stimulant

29
Q

Malignant obstruction mx

A

opioid for analgesia

antispasmodic for colic

Haloperidol

+/- octreotide

30
Q

Antispasmodic eg

A

Hyoscine butylbromide

31
Q

Octreotide

A

dry GI secretion

malignant bowel obstruction rx

32
Q

WHO analgesic ladder

A

Non opioids

Weak opioids

Strong opioids

33
Q

Non opioids

A

Paracematol

NSAID

34
Q

Weak opioid eg

A

cocodamol (30/500)

Tramadol

Tapentadol

35
Q

Strong opioid eg

A

Morphine

Diamorphine

Hydromorphone

Oxycodone

Fentanyl

Buprenorphine

Methadone

36
Q

Adjuvant analgaesic

A

Amatryptiline

Gabapentin

Pregabalin

Steroids

37
Q

Morphine metabolism

A

Liver metabolises to

  • M3G (inactive)
  • M6G (active)

Kidney -> excretion

38
Q

How steroids work as analgesic

A

reduces oedema around tumour, reduce compression

39
Q

Myoclonic jerks

A

opioid toxicity

symmetrical twitches

arms flexed (vs hepatic flap=arms extended)

40
Q

Morphine hallucinations

A

Ants/moths/bats/rats crawling/flying

Arms coming down from the ceiling

Hallucinating a close relative

41
Q

Pethidine use

A

labour

very short duration of action

doesnt distress fetal resp on delivery (still shouldnt be given within 2hours of delivery)

42
Q

Strong opioid in liver failure

A

Methadone

43
Q

Strong opioid in kidney failure

A

fentanyl

44
Q

Calculation for break through pain dose of opioid

A

1/6th of total 24hr morphine dose

45
Q

How much to increase opioid dose by if no pain relief

A

Increase total 24hr dose by 1/3rd

46
Q

How long does opioid induced constipation last?

A

Entire duration of opioid use

47
Q

How long does opioid induced N/V last?

A

~ 1 wk