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PPT Phase II > Palliative Care PPT > Flashcards

Palliative Care PPT Flashcards

1
Q

What is the first line anticipatory drug for nausea and vomiting and why?

A

haloperidol - because it’s once a day, long acting, and covers a large range of N&V

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2
Q

what route could you use in a cachectic person instead of IM?

A

subcutaneous route - unlicensced for most drugs

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3
Q

Which of the below would you discontinue at EOL?

Statins, treatment dose LMWH, prophylactic LMWH, opioids, iron?

A

statins, prophylactic LMWH, iron

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4
Q

name two common indications for a syringe driver

A

persistent N&V and severe dysphagia

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5
Q

do oral and subcutaneous doses have the same effect?

A

they should do as long as the patient is absorbing things properly

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6
Q

how strong is codeine in comparison to morphine?

A

codeine is 1/10th the strength of morphine

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7
Q

What is the mechanism of action of pregabalin?

A

acts on calcium channels to stop calcium coming into the cell whcih hyperpolarises the cell making it harder for an action potential to be formed

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8
Q

what class of drug is clonazapam?

A

benzodiazepine

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9
Q

what is the mechanism of action of clonazapam?

A

increases chloride in teh cell through GABA receptors.

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10
Q

Why might benzodiazepines make people sleepy?

A

because they are decreasing lots of neural pathways in teh brain and not just the pain pathway

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11
Q

what is the mechanism of action of opioids in terms of their pain relief effects?

A

they open potassium channels via G-protein coupled receptors, making them more negative (hyperplolarises cell) whcih reduces the chance of an action potential forming

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12
Q

name four ways in which opioids can cause harm

A
  1. Excessive side effects
  2. toxic by-products (metabolites)
  3. opioid induced hyperalgesia
  4. poorly informed patients and professionals
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13
Q

Name 3 GI side effects of morphine

A

constipation, xerostomia, N&V, delayed gastric emptying, GORD, constriction of the sphincter of Oddi

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14
Q

name 4 neurological effects of opioids

A

analgesia, delirium, hallucinations, sedation, myoclonus, hyperalgesia, seizures, headahces, euphoria, dysphoria, dependency

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15
Q

name two cardiovascular effects of opioids

A

bradycardia, hypotension

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16
Q

name 2 pulmonary effects of opioids

A

respiratory depression, decresased cough reflex, non-cardiogenic pulmonary oedema

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17
Q

name two urological effects of opioids

A

urine retention, decreased urine production

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18
Q

name an endocrinological effect of opioids

A

hypognoadism/sexual dysfunction, osteoporosis

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19
Q

what effect are opioids thoeught to have on immunity

A

thought to decrease immunity.

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20
Q

opioid induced bowel dysfunction causes what 3 effects?

A

cramps, slow bowel transit, dry hard stool

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21
Q

what are the two most common causes of opioid toxicity in EOL patients

A

poor prescribing/wrong dose given, pt has gone into renal failure (most opioids are excreted renally)

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22
Q

Name 4 of the most common side effects of opioid toxicity?

A

sedation, hallucinations, confusion/delirium, myoclonus, respiratory depression with hypoxaemia

23
Q

in opioid-induced respiratory depression, what two things do you need to see on observation for this to be the cause?

A

decreased resp rate (<8) AND subsequent decreased sats (<90%)

24
Q

how should you initially manage treating respiratory depression in a pt who is on morphine for cancer pain or EOL?

A

try shaking pt, high flow O2 if sats are low.

25
Q

What is the best antiemetic to use for chemotherapy induced N&V?

A

ondansetron.
surgery, chemo and radiotherapy can cause the release of serotonin from intestinal enterochromaffin cells. ondansetron might help with this as it is a 5-HT3 receptor antagonist

26
Q

What is a concerning side effect of high dose or long-term metoclopramide?

A

extra-pyramidal toxicity

27
Q

What is the mechonism of action of metoclopramide and domperidone?

A

5-HT4 and D2 antagonists

28
Q

which causes less side extrapyramidal side effects domperidone or metoclopramide?

A

domperidone as it doesn’t cross the BBB. however, can prolong QTc causing Torsades de point

29
Q

what is the mechanism of action of haloperidol? What situations is it a good anti-emetic to use?

A

D2 antagonist antiemetic that works on the CTZ.

good for when emesis is caused by chemicals, metabolites or drugs

30
Q

what is the MOA of levomepromazine and when is it a good anti-emetic to use?

A

5-Ht2, AChm, D2, H1 antagonist.

broad-spectrum antiemetic, often used second-line, or first-line when aetiology is uncertain or due to multiple causes

31
Q

what is the MOA of cyclizine?

A

H1 and AChm antagonist

32
Q

name 4 situations where cyclizine would be the antiemetic of chioce

A

bowel obstruction, motion sixkness, pharyngeal irritation, raised ICP.

33
Q

name two side effects of cyclizine

A

sedation, dry mouth, constipation etc.

34
Q

what are teh only two indications for using steroids (dexamethasone) as an antiemetic?

A

for N&V induced by chemotherapy or raised ICP

35
Q

name a somatostatin analogue that can be used to manage emesis caused by bowel obstruction by reducing secretions from the intestine and pancreas

A

octreotide

36
Q

in cancer patients who are anorexic and cachectic but who have something important to do i.e. father of the bride speech, what could you prescribe them temporarily that will help stimulate appetite and reduce fatigue?

A

dexamethasone 4-6mg per day (in morning to prevent insomnia)

37
Q

PRN dose of opioid for breakthrough pain tends to be what dose of the dose of the opioid they’re on?

A

1/6th of the dose of the opioid they’re on

38
Q

how much more potent is fentanyl than morphine?

A

~100x

39
Q

what pharmacoloigcal class of drugs could be given to reduce respiratory tract secretions in palliative patients?

A

anti-muscarinics e.g. glycopyroonium

40
Q

what drug is first line for restlessness or agitation in palliative care?

A

midazolam

41
Q

what is ssecond line drug for restlessness or agitation in palliative care? what is the main side effect?

A

levomepromazine - but it is very sedating

42
Q

what pharmacological thearpy whould you use first line for delirium?

A

haloperidol

43
Q

after giving haloperidol t a pt with delirium, if this hasn’t worked, what drug can you add in second line?

A

midazolam

44
Q

name 5 acute side effects of radiotherapy

A

fatigue, skin redness and itching, N&V, diarrhoea, abdo: cystitis, proctitis. oesophagus: oesophagitis, odynophagia, dysphagia.
Lung: cough, SOB due to pneumonitis.
Head and neck: hoarse voice, dysphagia, mucositis, skin pigmentation.
Brain: fatigue, hair loss

45
Q

name 5 late side effects of radiotherapy (occuring 6 months after)

A

fibrosis in skin causing thinning and lack of elasticity.
fibrosis in bowel causing strictures, stenosis, decreased motility.
deranged organ function. salivary glands affected can cause dry mouth.
pelvic radiotherapy can cause rectal bleeding and haematuria.
soft tissue necrosis and mucosal ulceration in severe cases.
brain: hypopituitarism, short term memory impairment.
secondary cancer.

46
Q

what are some of the long-term side effects of radiotherapy in children

A

growht retardation, hypoplasia of organ irradiated, secondary cancer

47
Q

what symptom is radiotherapy good for palliating?

A

bone pain caused by bone mets.

48
Q

in the palliative care setting. if N&V is thought to be due to reduced gastric mobility, what is first-line?

A

pro-kinetic agents such as metoclopramide and domperidone

49
Q

if N&V is chemically mediated and chemical distrubances have tried to be corrected, what are the best antiemetics to use?

A

ondansetron, haloperidol, levomepromazine

50
Q

what is the recommended antiemetic for N&V due to intracranial disease?

A

cyclizine or dexamethasone

51
Q

what is the first line antiemetic for N&V casued by vestibular disturbance?

A

cyclizine

52
Q

what antiemetics can be used for refractory vestibular causes of N&V?

A

treat alternatively with metoclopramide or prochlorperazine.
olanapine or risperidone could also be used

53
Q

what is the best antiemetic to use for N&V caused by anxiety, pain, fear and/or anticipatory nausea

A

short acting benzo such as lorazepam can be useful. if not, cyclizine. then can trial ondansetron and metoclopramide

PPT Phase II (37 decks)

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