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CCC - LM > Palliative Medicine > Flashcards

Palliative Medicine Flashcards

1
Q

Cancer pain occurs in what % of patients?

A

80%

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2
Q

Bone pain is described as what type of pain?

A

Dull pain often worse on weight bearing/with movement

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3
Q

Bone pain is treated with what?

A

NSAIDs
Radiotherapy
Bisphosphonates - pamidronate

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4
Q

Deep seated tenderness over a particular organ can be a sign of which type of pain?

A

visceral

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5
Q

Hyoscine butylbromide can be used to treat what type of pain?

A

Colicky pain - e.g. intestinal obstruction

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6
Q

A dull headache worse on leaning forward is treated with what agents?

A

Raised ICP headache
16mg dexamathasone to reduce oedema + cyclazine
NSAIDS & paracetamol

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7
Q

Pregabalin can be used to treat what type of pain?

A

Neuropathic

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8
Q

Liver capsule pain is a type of what pain? And how is it managed?

A

Visceral pain

Analgesic ladder

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9
Q

What is neuropathic pain?

A

Area of abnormal sensation - pins & needles, numbness, pallor/sweating
Abnormal pain due to damaged nerves

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10
Q

What does TENS stand for? And what is it used to treat?

A

Transcutaneous electrical nerve stimulation

Nerve pain where amitriptyline is inappropriate

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11
Q

What fraction of your 24 hour dose of morphine should the PRN dose be?

A

1/6

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12
Q

If morphine is not tolerated or ineffective, what is the alternative opioid?

A

Oxycodone - 2x more potent than morphine

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13
Q

How many times more potent is diamorphine SC compared to PO morphine?

A

3x

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14
Q

What opioids are available transdermal? And for how long does they last?

A

Fentanyl - 72 hours

Buprenorphine

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15
Q

What should always be prescribed in conjunction with an opioid?

A

Laxative

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16
Q

Name 3 preparations of co-codamol

A

8/500 2x QDS max
30/500 2x QDS max - is this doesn’t work, don’t increase codeine due to constipation
Instead move up ladder

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17
Q

Which patients should amitriptyline be avoided in and why

A

Cardiac patients - risk of arrhythmias

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18
Q

What are the strong opioids?

A

Morphine
Fentanyl
Oxycodone
Buprenorphine

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19
Q

Which weak opioid is rarely used in treatment of cancer pain?

A

Tramadol

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20
Q

Which antiemetic is used to counteract opioid N&V?

A

Haloperidol

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21
Q

When does drowsiness usually occur when taking opioids & when is it abnormal?

A

When starting or changing dose

Should subside in 48 hours - if prolonged then this is abnormal

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22
Q

If respiratory depression occurs due to opioid overdose, what is the management?

A

Naloxone

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23
Q

What are the signs of opioid toxicity?

A 
Persistent N&V
Persistent drowsiness
Confusion
Visual hallucinations 
Myoclonic jerks
Respiratory depression - late sign
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24
Q

What are the 2 types of morphine?

A

Immediate release

Modified/slow release

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25
Q

MST & Zomorph are what type of morphine and what is the duration of action?

A

Modified release

Lasts up to 12 hours - therefore take BD

26
Q

Oromorph is what type of morphine & what is the duration of action?

A

Normal/ immediate release
Works within 20-30 minutes & lasts 4 hours
Used as PRN

27
Q

What is the normal starting dose of MST?

A

15-20mg

28
Q

What is the maximum no. of doses you can take of PRN oromorph?

A

6 doses per day

Each dose = 1/6 of max dose in 24 hours

29
Q

How many times more potent is parenteral MST compared to oral morphine?

A

2x more common

Therefore divide max dose by 2 when converting PO to SC

30
Q

How can MST be delivered to someone not tolerating oral tablets?

A

Syringe driver over 24 hours

31
Q

What step of the analgesic ladder is oxycodone?

A

Step 3 - 2nd line after morphine

32
Q

What are the 2 preparations of oxycodone?

A

Oxynorm - immediate release

Oxycontin - slow release

33
Q

What is the medical term for dry mouth?

What are some causes?

A

Xerostomia
Palliative meds - antiemetics, antidepressants
Reduced intake of oral fluids - e.g. due to opioid N&V
Radiotherapy of head & neck

34
Q

What can be used to treat anorexia caused by opiate use?

A

Dexamethasone 4mg OD - effect wears off after 2-3 weeks

Megestrol acetate - 160mg OD - can cause fluid retention

35
Q

What are the 4 main causes of vomiting?

A

Toxic
Gastric
Cerebral
Vestibular

36
Q

N&V caused by ascites pressing on the stomach can be treated with which antiemetic?

A

Gastric cause - use metaclopramide

Or domperidone

37
Q

Posseting & retching is a sign of which type of N&V?

Which antiemetic should be used to treat this?

A

Toxic causes
Haloperidol - 1.5-5mg PO/sc nocte (at night)
Or levomoperizine

38
Q

Cyclamen is used to treat which type of N&V?

A

Raised ICP

39
Q

What are the side effects of metaclopramide?

A

EPSEs

Prolactinaemia

40
Q

Diazepam is used to treat what type of nausea? When can it occur?

A

Anticipatory nausea
E.g. before chemo/rx
Consultations/ bad news

41
Q

Fybogel is what type of laxative?

A

Bulk forming

42
Q

What are the softener laxatives?

A

Lactulose

Sodium docusate

43
Q

What is a side effect of lactulose?

A

Bloating

44
Q

What are the stimulant laxatives?

A

Senna
Danton
Sodium picosulphate

45
Q

What are the combination laxatives?

A

Movicol

Co-danthramer

46
Q

Which laxative causes orange urine?

A

Co-danthramer

47
Q

Which type of cancers most commonly cause intestinal obstruction?

A

Ovarian & bowel

48
Q

What are the symptoms of intestinal obstruction?

A

N&V
Abdominal pain & distention
Constipation/ overflow diarrhoea
Colicky pain

49
Q

What non-surgical treatment can be used for intestinal obstruction? How does it work?

A

Buscapan - hyosine butylbromide

Reduces bowel movement & pain

50
Q

What can be used to treat breathlessness in palliative patients?

A

Opioids to reduce respiratory effort

51
Q

What are common acute causes of breathlessness?

A

Asthma - bronchodilators
Pulmonary oedema - diuretics & diamorphine
PE - anticoagulants

52
Q

What if someone develops SoB over several days, what may be the cause?

A

Pneumonia - abx
COPD - abx & bronchodilators
SVCO obstruction - dex + & PPI + stent
Bronchial obstruction - dex + PPI +stent

53
Q

Name some causes of gradual onset SoB

A 
Heart failure - digoxin, diuretics, ACE-i
Anaemia
Pleural effusion - aspiration 
Ascites 
Lymphangitis carcinomatosis
54
Q

What is lymphangitis carcinomatosis

A

Inflammation of the lymph vessels caused by malignancy

Causes gradual onset SoB

55
Q

What are the 3 main causes of cough in palliative patients?

A

Excessive mucous production
Inhaled foreign body
Abnormal stimulation of bronchial receptors

56
Q

How can dry cough be treated pharmacologically?

A

Opioids - cough suppressants

E.g. codeine linctus

57
Q

What are the benefits of telling someone when they are palliative?

A

Reduces fear
Allows them to make non-medical decisions
Allows them to make preparations

58
Q

What is the gold standards framework and who is it for?

A

Patients in last year of life
Assesses current & future possible clinical needs
Plans for cross-boundary care
i.e. gives relevant contacts etc

59
Q

What does the AMBER in amber care bundle stand for?

A 
Assessment 
Management 
Best practice
Engagement 
Recovery uncertain
60
Q

Who is the AMBER care bundle for?

A

Those likely to die in the next 2 months

Aims for early conversation with carers & reduced hospital readmissions

CCC - LM (14 decks)

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