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4th Year > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

What are the non-drug aspects of palliative care?

A 
Self-help and education
Psychological support
Social support
Rehabilitation
Spiritual services
Bereavement care
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2
Q

How do you convert oral codeine/dihydrocodeine to oral morphine sulphate?

A

Divide by 10

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3
Q

How do you convert oral tramadol to oral morphine sulphate?

A

Divide by 10

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4
Q

What is the maximum daily dose of codeine?

A

240mg

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5
Q

What is the usual dose for codeine?

A

30-60mg 4hrly

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6
Q

What is the usual does of amitriptyline?

A

10mg ON working up to 75mg ON

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7
Q

What should you always prescribe with NSAIDs

A

Omeprazole 20mg OD

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8
Q

What should prescribe alongside opiates?

A

Metoclopramide 10mg TDS

Senna

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9
Q

What is the PRN dose of morphine if on MST?

A

1/6th of daily MST dose

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10
Q

How do you convert oral morphine to subcut MST?

A

Divide by 2

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11
Q

How do you convert oral morphine to subcut Diamorphine?

A

Divide by 3

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12
Q

What opiate should you use if they have poor renal function?

A

Oxycodone

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13
Q

How do you convert oral morphine to oral oxycodone?

A

Divide by 2

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14
Q

How do you convert oral to subcut oxycodone?

A

Divide by 2

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15
Q

How do you convert oral morphine to subcut oxycodone?

A

Divide by 4

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16
Q

How do you convert oral morphine to transdermal fentanyl?

A

Divide by 3.6

Mg -> micrograms

17
Q

When is oromorph effective?

A

After 30mins

Up to 4 hours

18
Q

When in MST (Zomorph) effective?

A

After 4 hours

Up to 12 hours

19
Q

What is the typical daily starting dose for morphine-naive patients?

A

20-30mg

20
Q

How should morphine dose be titrated?

A

Achieve stable daily dose with oromorph
Convert this dose to MST
Add in 1/6th PRN
Follow-up in 2wks

21
Q

Which opiates can be given by syringe pump?

A

MST
Oxycodone
Diamorphine

22
Q

How frequently are fentanyl patches applied?

A

Every 72hrs

23
Q

What doses of fentanyl patches are available?

A 
12micrograms
25mcg
50mcg
75mcg
100mcg

Need oral morphine PRN as well

24
Q

How often are Buprenorphine patches applied?

A

Every 7 days

5, 10, 20mcg

25
Q

How do you convert oral morphine to buprenorphine?

A

Divide by 1.7

Mg -> mcg

26
Q

What is good for skeletal muscle spasms?

A

Diazepam 2-5mg ON

27
Q

Which antiemetics may worsen Parkinson Sx?

A

Metoclopramide
Haloperidol
Levomepromazine

28
Q

Which antiemetics may be useful in those with Parkinson’s?

A

Domperidone

Ondansetron

29
Q

What are the features of intestinal obstruction in advanced cancer?

A

Nausea post meals
Vomiting undigested food
Dull aching or colicky pain
Distension

30
Q

What is the differential diagnosis of intestinal obstruction?

A

Constipation secondary to faecal impaction

31
Q

What drugs should be avoided with intestinal obstruction?

A

Metoclopramide

Laxatives if complete obstruction

32
Q

What drugs may help intestinal obstruction?

A

Hyoscine butylbromide = antispasmodic

33
Q

What are some stool-softening laxatives?

A

Lactulose
Movicol
Docusate

34
Q

What are some stimulant laxatives?

A

Senna

Bisacodyl

35
Q

What is the first line antiemetic in bowel obstruction?

A

Cyclizine or haloperidol

Cyclizine may be incompatible with Buscopan

36
Q

What is the first line antiemetic for chemical nausea?

A

Haloperidol

37
Q

What is the first line antiemetic for raised ICP

A

Dexamethasone +/- cyclizine

38
Q

What are the 4 anticipatory medications in SC?

A

Morphine 5-10mg/24hr
Haloperidol 500mcg PRN
Hyoscine butybromide 20mg PRN
Midazolam 2-5mg PRN

Remember water for injection

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