Brainscape's Knowledge GenomeTM

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


See full index

Y4 Cancer Care > palliative care > Flashcards

palliative care Flashcards

1
Q

Give 7 signs that someone is in their final days of life

A
  • profound weakness
  • more time in chair/ bed
  • gaunt
  • reduced appetite
  • weight loss
  • drowsy
  • disorientated
  • diminished oral intake
  • cannot take oral meds
  • increase in disease specific symptoms
  • poor concentration
  • cheyne stokes breathing pattern
  • skin colour change
  • incontinence
  • reduced UO
  • temperature change at extremities
  • agitation
  • raspy breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

state the standard 4 drugs, doses and indications that are given for anticipatory prescribing in end of life care

A
  • Morphine SC 2.5-5mg (opioid naive dose)PRN for pain and dyspnoea
  • Midazolam 2.5-5mg SC PRN for dyspnoea and agitation
  • glycopyrronium 200mg SC PRN or TDS for secretions
  • haloperidol 1.5-2.5 mg SC PRN for agitation and nausea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What considerations need to be made for advanced care planning?

A
  • psychosocial needs and fears
  • spiritual and religious needs
  • ongoing symptom management
  • resus
  • anticipatory prescribing
  • good after death care
  • food and drink, clinically assisted nutrition and hydration
  • mouth care
  • ceiling of care agreed
  • referral when complex symptoms
  • preffered place of death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can cause pain at end of life due to cancer

A
  • cancer invading bone, nerves, viscera, soft tissue
  • anti cancer treatments causing fibrosis, neuropathy, lymphodema, incision pain, mucositis
  • cancer related debility eg mucositis or neuropathy
  • concercurrent disorder eg OA, spinal stenosis, unknown
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What may exacerbate pain at end of life due to cancer?

A
  • anger
  • anxiety
  • boredom
  • discomfort
  • insomnia
  • social isolation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What may reduce pain at end of life (other than medications)

A
  • acceptance
  • relaxation
  • mood elevation
  • relief of other symptoms
  • sleep
  • explanation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the difference between nociceptive and neuropathic pain?

A
  • Neuropathic pain is due to nerve damage, it is shooting, burning, stabbing, numbness, allodynia, hypersensitivity
  • Nociceptive pain can be somatic (sharp, throbbing, localised) or visceral (diffuse, poorly localised, aching)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What NSAIDs can be given for a pt with CVS risk?

A
  • naproxen or ibuprofen

- avoid diclofenac

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

When should NSAIDs be used with caution?

A
  • CVS risk
  • GI risk (do not use)
  • heart failure (will exacerbate)
  • renal failure (will exacerbate)
  • give PPI with all
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What drugs can be used for neuropathic pain?

A
  • amitriptyline
  • gabapentin
  • pregabalin
  • often take around 5 days to work
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What drug is particularly good for boney pain

A
  • bisphosphonates (alendronic acid PO, zoledronic acid IV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Give 3 examples of weak opioids

A
  • dihydrocodeine
  • tramadol
  • codeine phosphate
  • cocodamol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give 3 examples of strong opioids

A
  • oxycodone
  • morphine
  • fentanyl
  • diamorphine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give 3 common side effects of opioids

A
  • constipation
  • dry mouth
  • N+V (goes after 5 days)
  • drowsiness/ sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What dose of morphine should be given PRN for breakthrough pain

A

1/6th the background daily dose

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

how are opioids excreted?

A
  • fentanyl and alfentanyl excreted by liver

- others excreted renally

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

What is the strength of morphine relative to codeine?

A

morphine 10x stronger than codeine

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

Give an example of immediate release and slow release morphine

A

IR: oramorph liquid or sevredol tablets
SR: zomorph capsules

19
Q

How do you calculate dose titrations for opioids?

A
  • calculated total daily dose (TDD) (background BD dose + PRN doses)
  • then do TDD/2
  • give this as BD slow release dose
  • then do TDD/6 and give this as PRN immediate release dose
  • principle is the same on syringe drivers but half it because its twice as strong via syringe driver bcos it bypasses the first pass metabolism
20
Q

What rules do you need to remember for controlled drug prescribing?

A
  • name and ID of pt, drug, form and strength
  • give total number of tablets or liquid needed in words AND figures
  • on TTO give enough for 14 days
  • for PRN cannot state ‘take as needed’ and should give enough for 4 doses a day for 14 days
    eg:
    Morphine SR (zomorph) capsules 10mg BD for 14 days, supply 28 (twenty eight) capsules
    Morphine sulphate solution (oramorph) 10mg/5ml. Can take 5mg PRN up to 1 hrly for breathrough pain. supply 1 (one) 300ml bottle
21
Q

How does impaired gastric emptying present? what can cause it?

A
  • epigastric pain, reduced appetite, fullness/ bloating
  • vomiting large volumes, usually relieves the nausea
  • caused by locally advanced disease, morphine/ anti cholinergic or autonomic neuropathy
22
Q

How should impaired gastric emptying be managed?

A
  • treat cause if possible

- give metoclopramide or domperidone for symptomatic relief

23
Q

How does chemical/ metabolic disturbances causing N+V present? what can cause it?

A
  • persistent nausea aggravated by the sight and smell of food
  • V doesn’t relieve N
  • causes inc drugs (morphine, abx, SSRI, digoxin), renal or hepatic failure, low Na, high Ca, sepsis, tumour toxins
24
Q

How are chemical/ metabolic disturbances causing N+V managed?

A
  • haloperidol or metoclopramide

- correct cause

25
Q

How does raised ICP causing N+V present and how is it managed?

A
  • V is projective
  • N worse in morning
  • worse on head movement, headache
  • causes by cerebral mets, haemorrhage, meningeal disease
26
Q

How is raised ICP causing N+V managed?

A
  • treat cause

- give cyclizine or/ and dexamethasone

27
Q

What causes N+V after radiotherapy and what is it treated with?

A
  • due to serotonin release

- treat with ondansetron

28
Q

What drugs are good for managing N+V due to malignant bowel obstruction?

A
  • cyclizine or dexamethasone
29
Q

What drugs are good to manage N+V associated with chemotherapy?

A
  • aprepitant

- hypnosis, acupuncture also have good evidence

30
Q

how should N+V due to constipation be managed?

A
  • laxatives
31
Q

What antiemetic is a good all rounder and can be used 2nd line for all causes?

A
  • levomepromazine

- can try combining different antiemetics, giving them SC and regularly

32
Q

How do metoclopramide and haloperidol work?

A 
Dopamine receptor (D2) antagonists - acts at chemoreceptive trigger zone (CTZ) which responds to toxins in blood.
Metoclopamide has some action at serotonin receptor also
33
Q

How does levomepromazine work?

A
  • D2 and serotonin receptor antagonost- acts at CTZ

- also inhibits mACH receptor at the vomiting centre which is why its so versatile

34
Q

How doe hyoscine work?

A

inhibits mACH receptor at VIII nucleus (acts on CTZ and vomiting centre)

35
Q

How does ondansetron work?

A

serotonin receptor antagonists - acts at vomiting centre which responds to CTZ, higher centres and autonomic afferents

36
Q

How does cyclizine work?

A

inhibits histamine receptor at VIII nucleus and vomiting centre

37
Q

What causes constipation in end of life?

A
  • Disease related: immobility, reduced food intake/ low reside diet, intrabdominal and pelvic disease
  • Fluid depletion: poor intake, lots of losses, vomiting, sweating, fistulae
  • Weakness- cant poo
  • Obstruction
  • Medications (opioids, diuretics, anticholinergics, SSRIs)
  • Biochemical disturbances (hypercalcaemia, hypokalaemia)
38
Q

Give an example of a stimulant and a stimulant/ softener?

A

stimulant: senna or bisacodyl
Both: sodium picosulphate

39
Q

Give an example of a softener?

A

docusate

40
Q

Give an example of an osmotic agent?

A

lactulose
movicol
laxido (macrogol)

41
Q

What drugs are good at palliating bowel obstruction?

A

octeride and buscopan- reduce GI secretions and hence volume of vomiting as well as reducing peristalsis

42
Q

Give 5 treatable causes of breathlessness that are common in palliative care

A
  • anaemia
  • PE
  • CCF
  • COPD
  • pneumonia
  • pleural effusion
  • pericardial efusion
  • SVCO
  • anxiety
43
Q

How is end of life breathlessness (of no specific cause) managed?

A
  • sit them up
  • open window/ give fan
  • oxygen if hypoxic
  • morphine (1-2mg PRN SC/ PO or 5-10mg/ day SC driver)
  • Benzos (lorazepam 0.5- 1mg SL PRN, midazolam 2.5mg SC PRN)
44
Q

How can insomnia in end of life be relieved?

A
  • appropriate room temp
  • blackout blinds
  • give steroids in the morning
  • avoid waking them at night
  • discuss psychosocial issues
  • zopiclone or benzos can be used to help re- establish normal sleep wake cycles but may cause delirium

Y4 Cancer Care (6 decks)

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