Palliative care + geris Flashcards
Tramadol to morphine conversion
divide by 10
DEXA scan T-scores for osteopenia and osteoporosis
Normal > -1
Osteopenia -1.0 - -2.5
Osteoporosis < - 2.5
What 3 things are DEXA scans adjusted for
Age
Ethnic factors
Gender
oral morphine to subcutaneous syringe driver morphine conversion
divide daily oral morphine by 2
Most drugs are compatible with water for injection in syringe driver, but for which 5 drugs is sodium chloride 0.9% recommended?
Granisetron
Ketamine
Ketorolac
Octreotide
Ondansetron
Cyclizine when given at high doses may be incompatible with which syringe driver pain medication
Diamorphine
Cyclizine is incompatible with quite a lot e.g. dexamethasone, ketamine, metoclopramide
When starting treatment with opioids in palliative care for advanced and progressive disease, what should be offered
Regular oral morphine
Modified release or immediate release
With PRN immediate release for breakthrough pain
If no comorbidities use 20-30mg MR/day with 5mg breakthrough
Breakthrough dose of morphine is what proportion of daily dose of morphine
One sixth
What opioid for pain relief is preferred to morphine in palliative patients with mild-mdoerate renal impairment
Oxycodone
What 3 opioids for pain relief is preferred to morphine in palliative patients with severe renal impairment
Alfentanil
Buprenorphine
Fentanyl
Metastatic bone pain may respond to which 4 options
Strong opioids
Bisphosphonates
Radiotherapy
Denosumab
When increasing the dose of opioids, the next dose should be increased by …%?
30-50%
Codeine to morphine conversion
Divid by 10
Oral morphine to oral oxycodone conversion
Divide by 1.5-2
Transdermal fentanyl 12mcg patch equates to how much oral morphine daily
30mg oral morphine
Transdermal buprenorphine 10mcg patch equates to how much oral morphine daily
24mg oral morphine
oral morphine conversion to subcutaneous (syringe driver) diamorphine
divide daily morphine by 3
conversion of oral oxycodone to subcutaneous (syringe driver) diamorphine
divide by 1.5
What antiemetics can be used in palliative care for nausea + vomiting due to gastric dysmotility + stasis (bloating)
Metoclopramide
Domperidone
i.e. DA receptor antagonists
Which antiemetic is preferred for raised intracranial pressure vomiting
Cyclizine
+/- dexamethasone, radiotherapy
Which antiemetic is preferred for chemically mediated disturbances vomiting
Ondansetron
Haloperidol
Levomepromazine
Which antiemetic is preferred for visceral/serosalvomiting
Cyclizine
Levomepromazine
+/- anticholinergics i.e. hyoscine
Which antiemetic is preferred for vestibular system vomiting
Cyclizine
(refractory = use metoclopramide or prochlorperazine, or olanzapine or prochlorperazine)
Which antiemetic is preferred for cortical/anticipatory nausea vomiting
Lorazepam or cyclizine
What opioid is most likely to cause constipation
Oxycodone
Hiccups in palliative care are treated with what 2 drugs
Chlorpromazine
Or haloperidol, gabapentin, dexamethasone
Syringe drivers: respiratory secretions & bowel colic may be treated by …
hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide
What to prescribe for reducing the discomfort associated with a painful mouth that may occur at the end of life
Benzydamine mouthwash
commenst cause of dementia in the UK
Alzheimer’s disease
MMSE cut off score for dementia
24/30 or less = dementia
Visual hallucinations with dementia suggests which type of dementia
Lewy body dementia
Difference between parkinsons disease and Lewy body dementia
LBD has progressive cognitive impairment BEFORE parkinsonism symptoms (motor tremor etc)
Cognition tends to be fluctuating
Visual hallucinations may also be seen
Diagnosis of Lewy body dementia - what are the investigations
Usually clinical!
Can use SPECT
What type of medications should be avoided in Lewy body dementia
Neuroleptics /anti-psychotics
Can develop irreversible parkinsonism
Management of Lewy body dementia
ACh-esterase inhibitors
e.g. donepezil, rivastigmine
Memantine
(same treatment as Alzheimers!)
First line sedative for elderly delirium as per 2006 Royal College of Physicians
Haloperidol 0.5mg oral
(NICE advocate haloperidol or olanzapine)
What is management for vascular dementia
NO MEDICATIONS!
treatment of alzheimer’s disease
- ACh-esterase inhibitors - donepezil, gala ntamine, rivastigmine. For mild to moderate
- Second line = memantine (NMDA receptor antagonist). For moderate to severe Alzheimer’s as an add on, or monotherapy in severe
Managing non-cognitive symptoms in dementia e.g. depression, agitation
NICE DOES NOT RECOMMEND ANTI-DEPRESSANTS
Consider antipsychotics if agitation, hallucinations
Donepezil contraindicated with patients who have…
bradycardia
SEs: insomnia
three types of frontotemporal lobe dementia
Frontotemporal lobe dementia (Pick’s disease)
Progressive non-fluent aphasia (CPA)
Semantic dementia
What score is widely used to screen for patients who are at risk of developing pressure areas?
The Waterlow score
in what ages is neuroimaging needed to diagnose dementia
ALL AGES
Frailty should be specifically assessed through the evaluation of gait speed, self-reported health status, or which questionnaire
PRISMA-7 questionnaire
