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Oncology > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

What is advance care planning?

A

Statement of wishes
Advance decision to refuse treatment
Lasting power of attorney (health & welfare/ finances) - will only come into effect if capacity is lost

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2
Q

Describe the character of bone pain

A 
Dull ache (may be a large area/ localised over the bone)
Worse on weight-bearing/ movement
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3
Q

What are 3 management options for bone pain?

A

NSAIDs (e.g. diclofenac)
Radiotherapy
Bisphosphonates (e.g pamindronate)

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4
Q

What is a common SE of bisphosphonates?

What is a serious SE?

A

Oesophagitis (avoid giving in upper GI disorders)

Osteonecrosis of the jaw

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5
Q

How should colicky pain be managed?

A

Anticholinergics (

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6
Q

What are two possible treatments to manage neuropathic pain?

A

Amitriptyline & gabapentin

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7
Q

What is a reasonable starting dose for oral Modified-release morphine?

A

15-20mg twice daily

Break-through dose of 5mg

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8
Q

What should be prescribed with an opioid?

A

laxative

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9
Q

What side effects would you warn patients about when starting them on opioids?

A

Constipation (almost universal)
N&V (usually settles in a few days)
Drowsiness (should improve in a couple of days)
Also warn of hallucinations, confusion & reduced RR

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10
Q

What are the 3 strengths of co-codamol?

A

Weak: 8 mg codeine & 500mg paracetamol
Mod: 15 mg codeine
Strong: 30 mg codeine

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11
Q

Give an example of immediate release morphine

A

Oramorph
Works in 20-30 mins
Lasts <4 hours

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12
Q

Give an example of modified/ slow release morphine

A

MST (morphine sulphate tablets)

Lasts <12 hours

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13
Q

What is a non-renally excreted alternative to morphine in patients with renal failure?

A

Fentanyl patches

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14
Q

How long are fentanyl patches effective for?

A

72 hours

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15
Q

Conversion of oral morphone to:

a) S/C morphine
b) Diamorphine

A

a) divide by 2

b) divide by 3

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16
Q

What is 2nd line for patients who don’t tolerate morphine?

A

Oxycodone

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17
Q

What are some causes of gastric stasis?

A

Tumour, liver mets, hepatomegaly, ascites

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18
Q

What are the characteristics of N&V from gastric stasis?

A

Lare vomits post-food
early satiety
Heart burn
Hiccups

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19
Q

How do you manage vomiting from gastric stasis?

A

Metaclopramide (promotes gastric emptying)

Given 30 mins before a meal

20
Q

Give 3 toxic causes of vomiting

A

Drugs
Electrolyte imbalance (e.g. hypercalcaemia, uraemia)
Infection

21
Q

What is 1st line for treatment of toxic N&V

A

Haloperidol

22
Q

What are 2 other treatments for toxic vomiting?

A

Cyclizine

Levomepromazine

23
Q

How do you treat N&V from raised ICP?

A

Dexamethasone plus cyclizine

24
Q

How can anticipatory N&V be managed?

A

Benzo (e.g. lorazepam)

consider CBT

25
Q

What anti-emetic is given for chemo-induced N&V

A

Ondansetron

26
Q

What 3 drugs commonly used in palliative care can cause constipation?

A

Opioids
Amitriptyline
Ondansetron

27
Q

Give 2 examples of stool softeners

A

lactulose & docusate

28
Q

What are 2 SEs of lactulose?

A

bloating & flatulence

29
Q

When should a stimulant (e.g. SENNA) be avoided?

A

If the patient has colic

30
Q

Give 2 examples of combination laxatives

A

Co-danthrusate & movicol

31
Q

A patient with lung cancer complains of passing painful, hard stools. What laxative would you give>

A

Docusate (stool softener)

32
Q

General NICE guideline for constipation in advanced disease

A

Start with SENNA

33
Q

What should you do if a patient hasn’t opened their bowels for 3 days?

A

Consider rectal exam/ use of suppositories & enemas

34
Q

What are the principles of managing intestinal obstruction?

A

Antiemetic, analgesic, antispasmodic

35
Q

Profound weakness, extended periods of drowsiness, disorientation, disinterest in food & drink and confinement to bed may indicate what?

A

That someone is approaching the last few days of life

36
Q

What may the benefits of withdrawing artificial hydration & nutrition be?

A

reduce vomiting & incontinence, less need for venepuncture

37
Q

What are the 4 anticipatory medications for syringe drivers?

What should they be mixed with?

A

Analgesic: Morphine sulphate
Anti-secretory: Hyoscine butylbromide
Anxiolytic: Midazolam
Anti-emetic: Haloperidol/ lecomepromazine

Water for injection

38
Q

When registering a death, for how long must you observe the body?

A

At least 5 minutes

39
Q

What are indications to refer a death to the coroner?

A

<24 hours of admission, poisoning, violence, use of medicinal product, self-harm, self-neglect, treatment/ procedure, occupational

40
Q

If you are registering a death, how recently must you have seen the patient alive?

A

Within the last 14 days

41
Q

What is the gold standards framework?

A
  1. Identify patients who may be in the last year of life
  2. Assess current & future clinical & personal needs
  3. Develop a care plan
42
Q

What 10 things must you consider when discussing death with a patient?

A
  1. Patient’s understanding
  2. What are their priorities?
  3. Preferred place of care & death
  4. Level of care
  5. DNACPR
  6. Spiritual needs
  7. Financial needs
  8. Symptom management
  9. ACP
  10. GSF
43
Q

Why wouldn’t you give diazepam in a syringe driver?

A

It is an irritant

44
Q

What sedative can be given 2nd line to midazolam?

A

Levopromazine (at higher doses, can cause irritation)

Also acts as an antipsychotic & anti-emetic

45
Q

Why is Hyoscine butyl bromide 1st line over hyoscine hydrobromide?

A

Doesn’t cross the BBB so doesn’t cause agitation or sedation

Oncology (8 decks)

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