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

Examples of immediate release morphine
Onset of these?
How long do they last?

A

Oramoprh soln or sevredol tablets

onset 20 mins last 4 hours

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

Examples of Slow release morphine
Onset of these?
How long do they last?

A

MST or Zomorph capsules
4 hours
last 12 hours

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

How do you work out the Opioid PRN dose from the total background dose?

A

PRN dose is 1/6th of the total 24 background dose

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

What do you write on the Opioid PRN dose ‘Max’ section?

A

6x/day

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

How do you increase the background opioid dose?

A

Increase by 30-50%

THEN RECALCULATE PRN DOSE

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

What opioids are preferred in the context of renal failure?

A

Oxycodone, Fentanyl/Bupre patches

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

What drugs are usually prescribed with opioids?

A

A laxative like Senna

Anti-emetic like haloperidol or cyclizine

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

How long do Fentanyl patches last?

A

Up to 72 hours

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

How long do buprenorphine patches last?

A

5/10/20 MCG last 7 days

35/52.5/70 MCG last 96 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Indications for opioid patches?

A

Stable pain, renal failure, cannot take oral medication

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

Signs of opioid Overdosing?

A 
Confusion
Drowsiness
Myoclonic jerks
Hallucinations 
Pinpoint pupils
RR<10
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Conversion rate for oral morphine to:

1) SC morphine
2) SC Diamorphine

A

1) oral to SC morphine then DIVIDE BY 2

2) Oral morphine to SC Diamorphine then DIVIDE BY 3

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

Immediate release oxycodone name?

Slow release oxycodone name?

A

Immediate release oxycodone name- Oxynorm

Slow release oxycodone name- Oxycotin

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

Indications for a syringe driver?

Does this indicate EoL?

A 
Cannot swallow
LoC/Dec Consciousness
Persistent N&amp;V
Intestinal obstruction
Malabsorption of drugs

Important to explain that this does not indicate EoL!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Analgesic ladder

A

1- Non-opioids
2- Weak opioids like Co-codamol 30/500
3- Strong opioids

+/- Adjuvants like NSAIDS/Amitryptiline, Gabapentin, AD, Corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Good treatments for bone pain

A

NSAIDS +/- RT/Bisphosphonates

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

Good treatment for bowel obstruction pain

A

Hyoscine butylbromide + Analgesic ladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treating headache due to raised ICP

A

Corticosteroids + NSAIDS/Paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Neuropathic pain treatment

A

Amitryptiline or Gabapentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Symptoms of N&V due to gastric stasis/irritation?

Treatment?

A

Sudden sickness, relief upon vomiting, heart burn

Metoclopramide B/C pro-kinetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of gastric stasis/irritation?

A

Stomach cancer, liver mets, Ascites, Dexamethasone, NSAIDS, Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Symptoms of N&V due to toxicity?

Treatment?

A

Constant sickness, vomiting does not provide relief, retching

Haloperidol or cyclizine
Can then try levomepromazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Causes of Toxicity related N&V

A 
Renal failure
Chemotherapy
RT
Opiates
Digoxin
Hypercalcaemia 
Electrolyte problems 
Infection
Liver failure
24
Q

Treating chemotherapy related N&V

A

Metoclopramide if post-med

Ondansetron +/- Dex if PRE-MED

25
Q

Symptoms of N&V due to cerebral irriation?

Treatment?

A

Early morning headache, vomiting, severe nausea, neuro symptoms

Dex or cyclizine

26
Q

Causes of N&V due to cerebral irriation?

A

Brain mets, Inc ICP, Sights/smells, anxiety before chemo, RT to brain

27
Q

How do you treat anxiety related nausea before chemotherapy?

A

Lorazepam

28
Q

Which anti-emetic is broad spectrum?

A

Levomepromazine

29
Q 
Anti-emetics...
5-HT3 antagonism?
Antipsychotic?
H1 antagonsim
D2 antagonist?
Various receptors?
A

5-HT3 antagonism- Ondanestron
Antipsychotic- Halperidol
H1 antagonsim- Cyclizine
D2 antagonist- Metoclopramide (Pro-kinetic)
Various receptorsLevomepromazine broad spec

30
Q

Examples of Softening osmotic laxatives

A

Lactulose

Docusate

31
Q

Examples of stimulating laxatives

When do you avoid these

A

Senna
Bisacodyl

During colic

32
Q

Softener and stimulating laxatives

When to use

A

Movicol
Co-danthrusate
Co-danthramer (Carcinogenic)

Infrquent, hard stools

33
Q

Symptoms of intestinal obstruction

A 
Post-prandial N&amp;V
Colicky pain
Dull ache
Distension
Relief on vomiting
34
Q

Managing intestinal obstruction symptoms

A

Levomepromazine
Hyoscine butylbromide
Opioid
Stop stimulants like Senn/Dantron

35
Q

What sign would indicate a patient likely has constipation and not obstruction

A

Presence of flatus

36
Q

What factors are considered for surgical intervention in intestinal obstruction ?

A 
Performance status
Disease status
Co-morbidities
Symptoms 
Level of obs
37
Q

best imaging modality for Intestinal obstruction

A

CT

38
Q

How can you relieve dyspnoea

A

Lorazepam PO

OR,,,

Midazolam and morphine sulphate SC

+/- Fan in face, relaxation, treat reversibility

39
Q

Signs that someone is approaching end of life

A 
Profound weakness
Confined to bed
Disorientation
Severely limited attention span
To weak to swallow
Losing interest in eating/drinkin
40
Q

Examples of medications that can be stopped in EoL

A 
Vitamins
Horomes
Statins
Abx
Anticoag
CS
CV drugs 
AD
41
Q

Examples of medications that should be continued in EoL

A 
Analgesia
Antiemetics
Antisecretories 
Anxiolytics
Insulin 
Anticonvulsants
42
Q

How do you treat terminal restlessness in EoL care

A

Check: Pain, Bladder, Bowels, Secretions, Family (May be reversible)

Midazolam SC up to 5mg

43
Q

What is a ‘death rattle’

How do you treat it?

A

Secretory movement in upper airways
Non-painful

Reposition
Hyoscine butylbromide

44
Q

Criteria for a screening tool for cancer

A

Able to detect early enough by simple tests to be cured
Sensitive and specific tests
Well tolerated test (E.G Bronchoscopy is not)
Easy, inexpensive, well publicised

45
Q

Current screening for…
Cervical cancer
Breast
CRC

A

Cervical- 25-64 smear every 3 years till 49 then every 5 years

Breast- 50-70 Women, Mammography every 3 years

CRC 60-74, Colonoscopies if at risk

46
Q

Indications for DNACPR

A

Approaching end stage of terminal disease
Worsening frailty and multi-morbidity
Long term condition with life threatening exacerbations
Lots of unplanned hospital admissions

CPR wont work, pt doesnt want it or not in their best interests

47
Q

Different co-codamol dosages

A

8/500
16/500
30/500

2X TAB 4X A DAY

48
Q

What route can codeine not be given via

A

IV

49
Q

What are the 4 anticipatory meds of palliative care

A

Analgesia
Anti-emetic
Hyoscine butylbromide
Agitation meds (Haloperidol/Benzo)

50
Q

What are the 2 steps to confirming death?

A

1) Check mechanical cardiac function= NO PULSE AND NO HEART SOUNDS (5 mins)
2) Absence of pupillary light reflex, corneal reflexes and motor response to supra-orbital pressure

TIME OF DEATH IS WHEN BOTH ARE FULFILLED

51
Q

What are sections 1a and 2a for on the death certificate

A 
1a= Immediate direct cause of death (1b/c are events that lead to this)
2a= Significant other co-morbidities that contributed

If you put organ failure you must put what it was secondary to!
NO ABBREVIATIONS/SYMBOLS

52
Q

Indications for coroner referral

A 
Mesothelioma 
Violence, trauma, injury
Toxic substance exposure
Self-harm/Neglect
Employment related
Unknown cause
Unknown identity
No attending practitioner 14 days prior to death/not available within a reasonable time of death
53
Q

Who fills out the death certificate?

A

A Dr who attended the patient during their last illness
within last 14 days
Must do it within 24 hours of being informed
Examine if crematorium planned

54
Q

If patient is agitated but not terminal then what drug is 1st line

A

Haloperidol

55
Q

Symptoms of terminal agitation?

What causative agents should be checked?

A

Restlessness, vocalisations, Emotional fluctuations

Remember to check: Pain, Bladder, Bowels, Family and compliance

56
Q

When to suspect delirium in agitation?

A 
Sepsis
Multi-organ failure 
Cannot focus
Confusion
Hallucinations 
Disorientation
57
Q

Treating agitation vs treating delirium

A

If agitated then consider midazolam

If delirious then make non-pharmacological changes (Routine, family involvement, same nursing staff, low lighting) and possibly consider adding haloperidol

Year 4 CCC (3 decks)

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