palliative care teach amk

Question 1

SHO ascertaining death

Answer 1

no response to verbal or pain stimulus 
carotid pulse absence 
pupils fixed and dilated 
no heart sounds for at least 2 minutes 
no breath sounds for at least 3 minutes

Question 2

who can fill in a death certificate

Answer 2

registered doctor
you provided care in the last illness before death
seen patent in last 28 days - 14 days pre covid
you have knowledge and belief of their death

if these are not met goes to coroner

Question 3

refer to coroner if

Answer 3

person died in custody 
hadn't been seen in last 28 dosa 
unknown cause 
someone to bake 
idnustriucal cause 
suicidal 
suspicious 
substance abus e
accidents 
after medical treatment like an operation

Question 4

anticipatory medications - just in case bag

hyoscine hydrobormide for metastatic cancer what does this medication do

Answer 4

reduces respiratory tract secretions

Question 5

what is in a just in case bag

morphine and diamorphine to treat pain and breathlessness

hyoscine ydrobromide to treat repsriaotry secretions - however it causes agitation

for agitation give midazolam for anxiety or haloperidol for hallucinations

nausea and vomiting five haloperidol or cyclizine if central if not orokinetic metaclompromide

Answer 5

cyclzine and hyoscine butyl bromide cannot go in the syringe driver together

cannot give metoclompromide and cyclizine together

Question 6

pain prescribing

person with dementia want to give them 1000mg of paracetamol what is the most appropriate route of admisnistration

Answer 6

rectal

dont do syringe as will put it out

Question 7

for pain prescription what route first

Answer 7

oral - always unless not tolerated

Question 8

rectal should be given when

Answer 8

nil by mouth or if agitated - rectal bleeding or prolapse

Question 9

SC via syringe driver good for Long time or unknown dose or combine medications what not

Answer 9

confused or very agitated and may cause skin irritation

Question 10

trasndermal - only if pain is stable and you know exact dose e.g.

Answer 10

fentanyl

Question 11

sublingual - instant pain relief i.e. if patients are being moved what drug I snroamly given

Answer 11

fentanyl

Question 12

uncontrolled pain currently on paracetamol, codeine and ibroprofen what is the most appropriate medication next to give

Answer 12

morphine

when choosing who analgesic ladder
stage 1 is non-opioid analgesics e.g. paraceatoml and ibuprofen
+/- adjuvant e.g. ibuprofen to paracetaom
stage 2 - weak opioids like codeine, dihydrocodeine and tramadol
+/-non opiod and then adjuvant
stage 3 - strong opioids e.g. morphne, diamorphine and oxycodone, buprenorphine, fentanyl and methadone - non opiod and adjuvant

Question 13

bone pain what medication

Answer 13

radiotherapy
adjuncts like anglesic ladder all the way to top
3rd bisphonates ( pamidronate)

at each stage add adjuncts like NSAIDs and increase dose to max before moving on

Question 14

neuropathic pain

Answer 14

amitryptiline

pregablin

Question 15

severe renal failure but requires opiod

Answer 15

alfentanil ( subcut)

Question 16

background dose medication are the dose base management.breakthrough pain is when the background medication is not controlling this. PMR is extra medication you can take with pain is not controlled

Answer 16

iftkaing breakthrough pain 2 or more times a day, regime needs to be altered e.g. background pain medication need to be increased

breakthrough pain is worked out as 1/6 of our background she therefore breakfhtoiuhg pain must all be increased

Question 17

if going from oral morphien to morphine subcut

Answer 17

half dose

Question 18

if going from oral morphien to oral oxycodone

Answer 18

half dose

Question 19

if going from oral morphien to oral codeine and weak opioids

Answer 19

1/10th of dose

Question 20

if anxiety causing nausea then give

Answer 20

lorezapam

Question 21

sodium decosate -laxative for what drug

Answer 21

morphine as causes constipation

Question 22

when do you give dexamethasone

Answer 22

in the morning to prevent night time restlessness

Question 23

if you’ve got raised ICP or movement related what antiemetic should you give

Answer 23

cyclzine

Question 24

motility disorders or clinical toxicity at do you give

Answer 24

metoclopromide

Question 25

post surgery anti-emetic

Answer 25

ondastetron

Question 26

patient has gastric Stasis an Parkinson s what anitemiet c

Answer 26

dimperidone

Question 27

patient has bowel obstruction but not suitable for surgery fro NG tube what should they be given

Answer 27

loperamide hydrochloride