Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 4 > Palliative medicine > Flashcards

Palliative medicine Flashcards

1
Q

What is meant by titration in pain medicine?

A

When a patient uses more frequent “as required” doses on top of their daily dose, the following day the “as required” is added onto their daily dose.

this keeps occurring until the symptoms settle and a balance is met

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some signs of opioid toxicity?

A 
Confusion 
Drowsiness 
myoclonus 
nightmares 
hallucination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What drugs can be used for N&V in patients?

A

Start with things such as metoclopramide *avoid in bowel obstruction due to the promotility effects

Ondansetron - 5HT3 antagonist can be used for severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the conversion from oral codeine to oral morphine?

A

divide by 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the conversion from oral morphine to subcut morphine?

A

Divide by 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a useful mechanism to aid shortness of breath in a terminally ill patient?

A

Hand fan over the patient

- due to temperature change of air stimulates reflexes to slow breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is an effective tool that can be used to aid the treatment received in hospice into a hospital setting?

A

Liverpool care pathway

- 4 step approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some common symptoms of palliative care?

A

Dry mouth

Excessive Respirations

Restlessness

Nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What drugs can be used for excessive respiratory secretions?

A

Hyoscine butylbromide

Glycopyrronium bromide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What drugs are used for nausea in palliative medicine??

A

Metoclopramide

Haloperidol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What drugs can be used for intractable hiccups?

A

Chlorpromazine
or
Haloperidol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What medication can be used for bowel obstruction pain?

A

Hyoscine Butylbromide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can be used for respiratory secretions?

A

Hyoscine hydrobromide

**remember secretions with “hydro”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What dose should be given when changing from oral morphine to SC diamorphine?

A

divide by 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which drugs are ideal to use in severe kidney disease for pain relief?

A

Fentanyl

Alfentanil

Buprenorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If you are switching someone from oral codeine to oral morphine, what dose should you give?

A

Divide by 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does metastatic bone pain respond too?

A

Analgesia
Bisphosphonates
Radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Confusion in a palliative patient, what is the management?

A

Look for reversible causes:

  • hypercalcaemia
  • infection
  • urinary retention

1st line: Haloperidol
2nd line: Chlorpromazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which drug is good for increased ICP pain?

A

Dexamethasone

20
Q

Between morphine and oxycodone, which is safer to prescribe in renal failure?

A

Oxycodone

preferred over morphine in CKD

21
Q

What is the treatment for constipation?

A

Hydration
Ensure privacy access to toilet

Senna - stimulant

Macrogol - osmotic

Phosphate enemas
glycerol suppositories

22
Q

How is breathlessness managed?

A

Remove causes

  • infection
  • effusion
  • arrhythmias etc

Low dose opioids for distress
+/-
Benzodiazepine for stress

23
Q

What are some approaches to dealing with a patients spiritual pain?

A

Remember the whole person when treating them

Provide companionship

  • palliative teams
  • Macmillan nurses
  • Chaplains

Remember spiritual pain can be exacerbated by physical pain
- look to sort these first

24
Q

What are some core features of the final days towards death?

A

Bed bound

Semi - comatose

Unable to take tablets

Only able to take small sips of water

25
Q

When a patient is entering the dying days, how should your general management change?

A

Focus treatment on symptom control

Stop carrying out daily investigations

Only treat reversible problems as appropriate towards symptoms - urinary retention

Rationalise medications

26
Q

What specific things are done as a person enters their last days of life?

A

Prescribe PRN end of life drugs

Start a syringe driver

Manage Agitation
- diazepams

Manage secretions

  • reposition
  • suction
  • hyoscine hydrobromide

Hydration

Plan for death

  • DNACPR
  • Die at home? - arrange with district nurses

Respond to changes in clinical situation

Communicate

27
Q

Which types of drugs can be put through a syringe driver?

A

Pain
- Morphine

Anxiety/ Agitation/ Delirium

  • Midazolam
  • Haloperidol

N&V

  • Cyclizine
  • Haloperidol
  • Levomepromazine

Respiratory secretions

  • Hyoscine Hydrobromide
  • Glycopyrronium

Seizures
- Midazolam

28
Q

What are the red flags for back pain?

A 
<20 years old, >55 years old 
Weight loss / Fever 
Taking steroids 
History of malignancy 
Disturbance of continence 
Saddle anaesthesia 
Thoracic spine tenderness 
Night pain
29
Q

Name some oncological emergencies:

A

Neutropenic sepsis

Spinal cord compression

Tumour lysis syndrome

Malignancy associated hypercalcemia

Superior Vena cava syndrome

Raised ICP

30
Q

What are some side effects of opioids:

A 
N&amp;V 
Constipation 
Drowsiness/ sedation 
Dry Mouth 
Hypotension - vasodilatory properties 
Respiratory depression
31
Q

In renal failure, what is the danger of using morphine?

A

Build up of toxic metabolites, especially:

  • M6G
  • M3G

M6G is the active form and will lead to the overdose.
usually first seen with myoclonus.

32
Q

Symptoms of hypercalcemia?

A 
Tiredness 
Confusion 
Depression
Anorexia 
Polydipsia 
Polyuria 
Constipation
\+/- 
Bone pain 
\+/- 
Renal pain
33
Q

What is the calculation of oral morphine to subcut?

A

divide by 2

34
Q

What is the calculation of oral morphine to diamorphine

subcut?

A

Divide by 3

35
Q

What is the calculation of oral codeine to oral morphine?

A

Divide by 10

36
Q

In a cancer patient, list several causes of symptoms of nausea:

A

Drugs:
- morphine, chemotherapy

ICP
- metastasis to brain

Pain
- induces feeling of nausea

Metabolic changes
- hypercalcemia

Gastric:

  • stasis
  • obstruction
37
Q

What is the calculation for working out the daily dose of modified release opioid?

A

Calculate the total daily dose + PRN.
the Following day the PRN should be added to the previous dose.

Divide into two 12 hour Modified release MST

38
Q

What should the dose of PRN be?

A

1/6 of the total daily dose

39
Q

What should be prescribed along with opioids?

A

Laxative

Antiemetic

40
Q

What are some of the complications with a PICC line/ Hickmann Line?

A

Infection

Thrombosis

Electrolyte imbalances

Osmotic changes

Vitamin deficiencies

Refeeding syndrome

41
Q

What are the types of pain experienced by people?

A

Biological
Social
Psychological
Spiritual

42
Q

What drugs can be given for itch?

A

Hepatic: Cholestyramine

Uraemia: Gabapentin

Unknown: Chlorpheniramine

43
Q

What drugs should be avoided in end stage liver disease:

A

NSAIDs
Codeine
Dihydrocodeine

44
Q

What things should be thought about when planning for death:

A

Speaking to family

Welfare and power of attorney

DNACPR

Prescribing anticipatory medicines - Just incase medicines

Contact with palliative care

45
Q

What are some reversible causes of deterioration in the dying patient?

A

Dehydration

Opioid toxicity

Hypercalemia

Delirium

Infection

Glucose levels - hypo/ hyper

46
Q

When are syringe pumps indicated and how are the medications delivered?

A

Persistent N&V

NIl by mouth

Gastric obstruction

Excessive medication load
- too much to continually inject or give orally

End of life days

**given Subcut

47
Q

What are some just incase medications that are commonly prescribed?

A

Opioids for pain
Antiemetics
Anti - Anxiolytics
Anti- secretory

Phase 4 (49 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions