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Palliative Care > Passmedicine > Flashcards

Passmedicine Flashcards

1
Q

What drug can be used to alleviate headaches caused by raised ICP due to brain cancer/mets?

A

Dexamethasone

It reduces oedema around brain mets

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2
Q

What painkiller should those with advanced/progressive disease be offered?

A

Regular oral modified release morphine with oral immediate release morphine for breakthrough pain

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3
Q

What dose of MR morphine and breakthrough morphine should you start with in someone with co-morbidities?

A

20-30mg MR

5mg for breakthrough

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4
Q

What should be co-prescribed with opioids?

A

Laxatives

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5
Q

What are common symptoms with opioid use and how can they be avoided?

A

Nausea
Often it is transient but if it persists can offer anti-emetics

Drowsiness, usually transient but dose can be altered if req.

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6
Q

How do you calculate how much breakthrough morphine to use?

A

1/6th the daily dose of morphine

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7
Q

In which group of patients should opioids be used very carefully?

A

In those with chronic kidney disease

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8
Q

What are the preferred opioids to use in CKD?

A

Alfentanil, buprenorphine, fentanyl

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9
Q

What is metastatic bone pain most likely to respond to?

A

Strong opioids
Bisphosphonates
Radiotherapy
Denosumab

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10
Q

By how much should you increase an opioid dose at a time?

A

30-50%

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11
Q

Which side effect of opioid use is usually persistent?

A

Constipation

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12
Q

How do you convert a codeine dose to an oral morphine dose?

A

Divide by 10

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13
Q

How do you convert a tramadol dose to oral morphine?

A

Divide by 10

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14
Q

How does oxycodone differ from morphine?

A

Usually causes less sedation, vomiting + pruritus but more constipation

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15
Q

How do you convert a morphine dose to an oxycodone dose?

A

Divide by 1.5-2

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16
Q

How much does a transdermal fentanyl 12microgram patch equate to in oral morphine?

A

30mg daily

17
Q

How much does a transdermal fentanyl 10microgram patch equate to in oral morphine?

A

24mg daily

18
Q

How do you convert an oral dose of morphine to a s/c dose?

A

Half it

19
Q

How do you convert an oral dose of morphine to a s/c diamorphine dose?

A

Divide by 3

20
Q

How do you convert an oral dose of oxycodone to s/c diamorphine?

A

Divide by 1.5

21
Q

What drugs are used for the treatment of intractable hiccups?

A

Chlorpromazine
Haloperidol
Gabapentin
Dexamethasone (if hepatic lesions)

22
Q

When should a syringe driver be considered in palliative care?

A

If patient unable to tolerate oral meds, e.g. dysphagia, nausea, intestinal obstruction, weakness, coma etc.

23
Q

What are the two types of syringe drivers in the UK?

A

Graseby MS16A (blue) - delivers in mm per hour

Graseby MS26 (green) - delivers in mm per 24h

24
Q

Which drugs should you mix with sodium chloride when preparing for injection with syringe driver?

A 
Granisetron
Ketamine
Ketorolac
Octreotide
Ondansetron
25
Q

What drugs can be put through a syringe driver for nausea and vomiting?

A

Cyclizine
Levomepromazine
Haloperidol
Metoclopramide

26
Q

What drugs can be put through a syringe driver to help break up respiratory secretions?

A

Hyoscine hydrobromide

27
Q

What drugs can be put through a syringe driver to help with bowel colic?

A

Hycosine butylbromie

28
Q

What drugs can be put through a syringe driver to help with agitation and restlessness?

A

Midazolam
Haloperidol
Levomepromazine

29
Q

What drugs can be put through a syringe driver for pain?

A

Diamorphine is the preferred opioid

30
Q

What should you do if a palliative patient is confused/agitated?

A

Investigate for underlying causes, e.g. hypercalcaemia, infection, urinary retention, medications

31
Q

What medications can you give to help with confusion/agitation?

A

First line: haloperidol

Second line: chlorpromazine, levomepromazine

32
Q

What best treats agitation/restlessness in the terminal phase of the illness?

A

Midazolam

33
Q

Can you give a patient excess morphine if they are close to dying to end their suffering?

A

No - we must always start with a presumption in favour of prolonging life and not hasten death

34
Q

What is the first line pain killer in palliative patients who are unable to take oral medications?

A

Transdermal opioid patches (e.g. transdermal fentanyl patch 12micrograms/hour)

35
Q

What is allodynia?

A

Pain experienced with non painful stimulus

36
Q

What is hyperalgesia?

A

Severe pain experienced from mildly painful stimulus

37
Q

How is morphine metabolised in the body?

A

Morphine is metabolised in the liver by glucuronidation to morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G). M3G is probably inactive. M6G has analgesic properties but is also responsible for the toxicity.

38
Q

In which organ does the majority of the excretion of the active metabolites of morphine take place?

A

Kidneys

39
Q

What are the possible clinical features of opioid toxicity?

A

Altered consciousness, confusion, vivid dreams, pseudohallucinations, hallucinations, myoclonus, and sometimes hyperalgesia and whole body allodynia

Palliative Care (2 decks)

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