Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YEAR 4 - CCC > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

What is the WHO pain ladder?

A

Step 1: Paracetamol
Step 2: Weak opioid e.g. codeine + paracetamol (co-codamol)
Step 3: Strong opioids e.g. morphine, diamorphine, fentanyl, oxycodone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the different strengths of codeine?

A 
Weak = 8mg codeine + 500mg paracetamol
Middle = 15mg codeine + 500mg paracetamol
Strong = 30mg codeine + 500mg paracetamol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the initial dose of morphine for those on the maximum dose of weak opioids?

A

MST or Zomorph capsules 15-20mg BD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How much prn oromorph can you give to someone on slow release morphine?

A

1/6th of their total 24hr morphine dose

e.g. patient on MST 30mg bd should have oromorph 10mg prn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What can be used to manage bone pain?

A

IV bisphosphonates

Radio/chemotherapy to reduce size of tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can be used to manage liver capsule pain?

A

NSAIDs or corticosteroids to reduce inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can be used to manage neuropathic pain?

A

Gabapentin
Pregabalin
Amitryptiline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When should you use oxycodone over morphine?

A

Low eGFR

If morphine causing a lot of nausea and constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some side effects of morphine?

A
  • > 90% constipation - start them on laxative
  • 30% nausea + vomiting - would begin within a week of starting morphine; don’t always start them on anti-emetic but can put them on PRN so they can have if they need
  • Drowsiness - should settle within 72 hours but if it doesn’t check that they don’t have impaired renal function; don’t drive when starting it or changing the dose
  • Physical dependence (psychological addiction wont happen)
  • Respiratory depression - if dose is wrong
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When are opioid patches appropriate to use?

A

If pain is stable
If poorly compliant with oral medication
If patient has problems swallowing
Severe renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some non-pharmacological pain-management adjuvants?

A
  • Transcutaneous electrical nerve stimulation
  • Heat therapy e.g. pads
  • Palliative radiotherapy
  • Nerve block
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can be given to relieve muscle spasms?

A

Baclofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some treatments for non-reversible breathlessness?

A

Relaxation
Hand-held fan
Oromorph
Lorazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you know someone is dying?

A
  • Reduced oral intake
  • Sleeping more
  • Not taking medication
  • Cheyne-Stoke respiration
  • Increased secretions
  • Confusion
  • Terminal agitation
  • Unresponsive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 4 anticipatory medications?

A
  1. Midazolam
  2. Hyoscine butylbromide/glycoporonim (anticholingergic) if hyoscine insufficient
  3. Levomepromazine/haloperidol
  4. Morphine/oxycodone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 4 vomiting pathways?

A

Cerebral
Toxic
Gastric
Vestibular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is the nausea/vomiting different in toxic and gastric pathways?

A

Toxic = lots of nausea, frequent small quantities, retching

Gastric stasis = large volume of vomit once or twice a day, minimal nausea

18
Q

What can cause vomiting via the cerebral pathway/

A

Primary brain tumour or brain metastases
Raised intracranial pressure
Emotions

19
Q

What can cause vomiting via the toxic pathway?

A 
Opioids
Hypercalcaemia
Uraemia
Jaundice
Infections
20
Q

What is the broad spectrum antiemetic?

A

Levomepromazine

21
Q

What antiemetics are most appropriate for vomiting from gastric pathway?

A
  1. Metoclopramide
  2. Domperidone

They are pro-kinetic so increase speed at which food exits the stomach

22
Q

What antiemetics are most appropriate for vomiting from toxic pathway?

A
  1. Haloperidol
  2. Cyclizine
  3. Levomepromazine
23
Q

What should be given to a patient with emotion-related vomiting?

A

Benzodiazepines

24
Q

What should be given to someone vomiting due to increase intracranial pressure?

A

Dexamethasone with cyclizine

25
Q

What antiemetic is mostly used for nausea and vomiting related to chemotherapy?

A

Ondansetron

26
Q

What is the main side effect of ondansetron?

A

Constipation

27
Q

Give examples of stimulant laxatives

A

Senna - NICE recommended 1st line treatment for constipation

Bisacodyl

28
Q

Give examples of stool softeners

A

Lactulose = osmotic laxative

Docusate capsules = emollient stool softener (liquid form tastes awful)

29
Q

Give examples of combination stimulant + softener laxatives

A

Macrogol

Co-danthrusate

30
Q

What opiates are safest in severe chronic kidney disease/low eGFR?

A

Fentanyl or Buprenorphine - both undergo hepatic metabolism and are not excreted by the kidneys

31
Q

What type of drug is ondansetron?

A

5HT3 receptor antagonist

32
Q

What drug is used for the management of intractable hiccups?

A

Chlorpromazine

33
Q

What are most suitable drugs for agitation and confusion (not terminal phase)?

A

First line: haloperidol

Others: chlorpromazine, levomepromazine

34
Q

How is death confirmed by a doctor?

A
  1. Individual should be observed for a minimum of five minutes
  2. Absence of mechanical cardiac function is confirmed using a combination of:
    - Absence of central pulse on palpation
    - Absence of heart sounds on auscultation
  3. After 5 minutes of continued cardio-respiratory arrest confirm the absence of:
    - Pupillary responses to light
    - Corneal reflexes
    - Motor response to supra-orbital pressure
35
Q

Who can complete a death certificate?

A

Completed by a doctor who attended the patient during their illness and has seen them within the last 14 days

36
Q

What goes in sections 1 and 2 on the death certificate?

A

Section 1 = immediate, direct cause of death on line 1a then go back through the sequence of events/conditions that led to the death

Section 2 = significant comorbidities not contributing to the cause of death in section 1

37
Q

Give examples of causes of death that require referral to HM Coroner

A
  • Poisoning or exposure/contact with toxic substance
  • Use of medicinal product
  • Violence, trauma, injury
  • Self-harm
  • Neglect and self-neglect
  • Medical procedure
  • Injury/disease attributable to any employment e.g. mesothelioma
38
Q

What is a syringe driver?

A

A syringe driver is a portable, battery driven device which delivers a continuous infusion of drugs over a predetermined time.
In palliative care it is normal to use a syringe driver to infuse drugs via the subcutaneous route, as drugs are generally well absorbed and the sites can easily be changed by nursing staff.

39
Q

What are the indications for a syringe driver?

A
  • Inability to swallow drugs due to reduced conscious level, often in the last few days of life
  • Persistent nausea and vomiting
  • Intestinal obstruction
  • Malabsorption of drugs
  • Dysphagia

Inadequate pain control is not an indication for syringe driver use unless there is reason to believe oral analgesics are not being absorbed.

40
Q

Which drugs are unsuitable for subcut administration and why?

A

Diazepam
Chlorpromazine
Prochlorperazine

They are too irritant

YEAR 4 - CCC (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions