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Ageing > Palliative medicine > Flashcards

Palliative medicine Flashcards

1
Q

What are Advanced Care Plans ACPs

A

Made with patients wishes in mind for end of life care

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2
Q

Step 1 in pain management

A

Paracetamol 1g x4daily
+- NSAID e.g. naproxen 500mg x2daily
+- other adjuvant

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3
Q

Step 2 in pain management

A

Codeine phosphate 30-60mg x4daily
or
Co-codamol 30/500 mg 2 tablets x4daily

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4
Q

Step 3 in pain management

A

STOP codeine

Start strong opioid, usually morphine sulfate

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5
Q

Give example of adjuvants and their uses

A

MSK pain –> NSAID
Neuropathic pain –> gabapentin, tricyclic antidepressant
Can be added at any point in WHO analgesic ladder

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6
Q

What are the different types of pain and what kind of morphine is used

A

Background pain - modified release morphine

Breakthrough pain - immediate release morphine

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7
Q

Give examples of modified release morphine (MR)

A

MST, zomorph

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8
Q

Give examples of immediate release morphine (IR)

A

sevredol tablets

oramorph liquid

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9
Q

How do you calculate the dose of immediate release morphine for breakthrough pain

A

1/6th of total modified release morphine

e.g. 30mg MR –> 5mg IR morphine

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10
Q

10mg PO morphine = ? SC morphine

A

5mg SC morphine

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11
Q

10mg PO morphine = ? PO oxycodone

A

5mg PO oxycodone

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12
Q

What are some signs of morphine toxicity

A 
Hallucinations 
Vivid dreams 
Confusion 
Myoclonus (jerky flicking movements)
Sleepiness 
Pin point pupils 
Respiratory depression
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13
Q

Management of opioid toxicity is to completely reverse all opiates in body, true or false

A

FALSE, these patients are still suffering from pain and so still need opioids for pain control

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14
Q

Management of opioid toxicity

A

Check renal function (U+E, GFR)
switch to a non-renally excreted opioid
fluids to dilute opioid in system
Naloxone is for serious toxicity ie respiratory depression

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15
Q

List reversible factors that may mimic death

A 
Drug toxicity 
AKI 
Hypercalcaemia 
Hypoglycaemia 
Sepsis
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16
Q 
Which medicines can be prescribed for the following symptoms at end of life:
Pain/SOB
Distress 
Nausea 
Respiratory secretion
A

Morphine
Midazolam
levomepromazine
hyoscine/buscopan

17
Q

What is done when confirming death

A 
check for: 
spontaneous movements and respiratory effort 
response to voice + pain 
palpate 2 major pulses for 1 min
eyes: dryness, clouding cornea, fixed dilated pupils, no corneal reflex
auscultate heart and lungs for 1 min 
NOTE any metallic device eg pacemaker
Record time and date of death
18
Q

PO morphine to SC diamorphine conversion

A

divide by 3

19
Q

PO morphine to SC morphine conversion

A

divide by 2

20
Q

PO morphine to PO oxycodone

A

divide by 2

21
Q

PO oxycodone to SC oxycodone

A

divide by 2

Ageing (8 decks)

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