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Virtual Ward > Palliative care > Flashcards

Palliative care Flashcards

1
Q

What are the different grades of the ECOG Performance Status?

A

0: fully active, able to carry on all pre-disease performance without restriction
1: restricted in physical strenuous activity but ambulatory and able to carry out work of a light or sedentary nature
2: ambulatory and capable of all selfcare but unable to carry out any work activities: up and about more than 50% of waking hours
3: capable to only limited selfcare: confined to bed or chair more than 50% of waking hours
4: completely disabled: cannot carry on any selfcare: totally confined to bed or chair
5: dead

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2
Q

What are the side effects of androgen deprivation therapy?

A

hot flushes, lowered libido, weight gain

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3
Q

Discuss the physical, social, psychological and spiritual impacts on a patient’s perception of patient.

A

Physical: pain due to disease, other symptoms e.g. nausea, physical decline and fatigue
Social: relationships, role in family, work, finances
Psychological: grief for lost life/meaning, depression, anxiety, adjustment
Spiritual: existential issues, religion, meaning of life, personal value

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4
Q

What is the difference between nociceptive and neuropathic pain?

A

Nociceptive: caused by injury, physical pressure or inflammation and detected by nociceptors throughout the body
Neuropathic: caused by damage to peripheral or CNS e.g. diabetic neuropathy

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5
Q

What are the two types of nociceptive pain?

A

Somatic: pain arising from injury or infiltration of skin, muscles, tendons or bone
Visceral: infiltration, compression, distension of thoracic and abdominal viscera (liver, bowel, heart, pleura)

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6
Q

How do opioids cause constipation?

A

they inhibit gastric emptying and peristalsis in the GI tract which results in delayed absorption of medications and increased absorption of fluid which leads to hardening of stool and constipation

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7
Q

What are some examples of weak and strong opioids?

A

Weak: codeine, tramadol, low-dose morphine
Strong: morphine, fentanyl, oxycodone, hydromorphone, buprenorphine

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8
Q

What are some of precipitating factors of opioid toxicity?

A

rapid dose escalation
renal impairment
sepsis
drug interactions

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9
Q

What is myoclonus?

A

sudden, brief, involuntary muscle jerks which can be either irregular or rhythmic

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10
Q

What are some of the opioid toxicity?

A 
delirium
vivid dreams/nightmares
persistent sedation
myoclonus
peripheral shadows/hallucinations
hyperalgesia
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11
Q

Discuss the management of opioid toxicity.

A
  • dose reducing
  • switching to alternative opioid
  • IV fluids (renal impairment)
  • oxygen and naloxone only considered if there is evidence of severe respiratory depression (RR>8)
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12
Q

What are the treatment options for oral candidiasis?

A

nystatin 1ml QDS 7 days

more extensive: fluconazole 50mg OD 7 days

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13
Q

What symptoms should anticipatory medications manage?

A 
pain
shortness of breath
agitation
nausea and vomiting
respiratory secretions
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14
Q

What are some things included in an anticipatory care plan?

A

preferred place of care
details of next of kin
level of intervention preferred
resuscitation status

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15
Q

What is an anticipatory care plan?

A

a dynamic record developed over time through an evolving conversation, collaborative interactions and shared decision making. It is a summary of Thinking Ahead discussions between the person, those close to them and the practitioner

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16
Q

Where is the vomiting centre located?

A

medulla oblongata

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17
Q

What is the chemoreceptor trigger zone?

A
  • located outside blood brain barrier
  • base of 4th ventricle, area postrema
  • direct connection to vomiting centre
  • detects changes the rest of the brain is protected from
18
Q

What triggers the CTZ?

A

biochemical: hypercalcaemia, hyponatraemia, renal failure, liver failure
chemical: opioids, antibiotics, iron, SSRI, digoxin, CINV

19
Q

Discuss the clinical picture of gastric outlet obstruction.

A
  • likely secondary to tumour or hepatomegaly
  • intermittent large volume vomit usually gives temporary relief of symptoms
  • early satiation
  • reflux and hiccups
  • often little nausea until immediately before sick
20
Q

What causes gastric outlet obstruction?1

A
  • delayed gastric emptying: drugs, tumour infiltration, hepatomegaly, ascites
  • bowel obstruction
  • severe constipation
  • pharyngeal stimulation
21
Q

Where is the vestibular pathway located and what is it responsible for?

A
  • inner ear
  • balance and space
  • signals via CNVIII to brainstem via vesticular nuclei
22
Q

What triggers the vestibular pathway?

A

motion sickness

morning sickness

23
Q

What type of drug is metoclopramide?

A

dopamine antagonist

24
Q

What is the site of action of metoclopramide?

A

CTZ, GI tract

25
Q

What are the side effects of metoclopramide?

A

movement disorder

cramping/diarrhoea

26
Q

When is metoclopramide contraindicated?

A

Parkinson’s

<20 years old

27
Q

What are the first line used to metoclopramide?

A

impaired gastric emptying (ilueus) opiates

biochemical causes of vomiting

28
Q

What is the site of action of cyclizine?

A

histamine and anti-muscarinic
vomiting centre
vestibular system

29
Q

What are the side effects of cyclizine?

A

dry mouth

sedation

30
Q

What are the contraindications of cyclizine?

A

heart failure as can cause tachycardia and decompensate patient

31
Q

When is cyclizine used as the first line drug?

A

intracranial of N/V - raised ICP, motion sickness

complete bowel obstruction

32
Q

What is the site of action of ondansetron?

A

serotonin receptos
vagal nerve
CTZ

33
Q

What are the side effects of ondansetron?

A

constipation, headache

reduces analgesia effect of tramadol

34
Q

What are the clinical uses of ondansetron?

A

chemo/radiotherapy induced nausea
GI distension/obstruction
post-op
opioid induced

35
Q

What is the site of action of haloperidol?

A

potent dopamine antagonist

CTZ

36
Q

What are the side effects of haloperidol?

A

neuroleptic malignant syndrome
movement disorder
QT prolongation

37
Q

What is the main contraindication of haloperidol?

A

PD

38
Q

Haloperidol is the first line drug in which causes of N/V?

A

hyponatraemia
hypercalcaemia
hiccups
delirium

39
Q

What receptors does levomepromazine act on?

A

dopamine, seratonin, acetylcholine, histamine, muscarinic

40
Q

What are the side effects of levomepromazine?

A

sedation
postural hypotension
increased seizure risk
avoid in PD

41
Q

When should levomepromazine be used in N/V?

A
  • if not indeterminate cause

- if first line treatment fails

Virtual Ward (11 decks)

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