Brainscape's Knowledge GenomeTM

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


See full index

Geriatric-Palliative > Symptom control / Cancer pain > Flashcards

Symptom control / Cancer pain Flashcards

1
Q

What is the medication used in palliative care for pain symptoms control?

A
  • Morphine sulfate (1st line),
  • oxycodone (2nd line),
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the medication used in palliative care for pain symptoms control if renal impairment?

A

fentanyl/alfentanyl or

buprenorphine (renal impairment)

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

What medication is used for pain control if Nil by mouth/unsafe swallow?

A

transdermal fentanyl if NBM/ unsafe swallow

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

As well as just giving pain meds for palliative pain what else should be done?

A
  • non-medical managment: support etc
  • + treat cause of bone pain
  • e.g. urinary retention, bowel spasm, bony mets –>
  • if metastatic bone pain = bisphosphonates or radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the medication used for agitation?

A

Midazolam 2.5-5mg/4h

Or levopromazine 12.5mg SC 6-12hrly

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

What medications / must be done for N&V?

A

Haloperidol 1-2.5mg/8h

or cyclizine 50mg/8h,

+ treat reversible causes e.g. laxatives (constipation can –>N&V)

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

What medication is used for the symptom control of respiratory secretions?

A

Hycosine hydrobromide 0.4mg/8h

or glycopyrronium 1.2-2mg/24h SC

(anti-cholinergics)

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

antacids, chlorpromazine and haloperidol can helpn with what palliative symptoms?

A

Hiccups

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

O2, morphine, relaxation techniques, open windows & fans can help with what palliative symptom?

A

SOB

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

emollients, chlorphenamine, cetrizine, colestryamina and ondanestron can help with which palliative symptom?

A

Pruritus

Chlorphenamina = anti histamine

colestryamine = obstructive jaundice

Ondansetron (5HT antagonist dc comm. in the vomiting centre)

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

Saline neds, antihistamines, simple/codeine linctus, morphine

all help with what palliative symptom?

A

cough

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

checking: Ca2+ or dehydration,

& try bisacodyl 5mg at night

helps with what palliative symptom?

A

constipation

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

How can palliative pts look after their mouths?

A
  • treat any candida infections,
  • chewing ice chips/pineapple chunks/gum;
  • mouth washes,
  • chlorhexidine & saliva substitutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do D2 antagonists, H1 antagonists, phenothiazines and 5HT antagonists all have in common?

A

they can act as N&V prophylaxis and treatment!

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

metoclopramide & domperidone are D2 antagonists what are their MOA & indications…?

A
  • block dopamine in the chemoreceptor trigger zone (CTZ)
    • TF used in drug induced nausea
  • & works in the GUT promoting gastric empyting
    • TF good for opioids, gastroparesis

Indication: N&V (prophylaxis & treatment) - particularly reduced gut motility

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

What are the adverse effects & CI/interactions of metroclopramide and domperidone?

A

(D2 antagonists used for N&V proph and Rx - particularly in reduced gut motility)

Adverse effects TF:

  • Diarrhoea (inc gastric emptying)
  • extra pyramidal
  • acute dystonic reaction

Contraindications:

  • CI: gastrointestinal obstruction & perforation (pro-kinetic)
  • Caution: SE’s ↑common in children & young adults
  • Interactions: extra-pyramidal SEs↑w/ anti-psychotics, don’t prescribe w/ Parkinson’s meds (as these are D2 agonists)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cyclizine, cinnarizine and promethazine are all H1 antagonists. WHat are their MoA and indications?

A
  • Block H1 & Ach musc in vomiting centre & vestibular system
    • Rx: N&V of a wide range of causes - (drug, post-op, radiotherapy) - prophylaxis & treatment
    • particularly motion sickness or vertigo
18
Q

What are the adverse effects and CI/interactions of Cyclizine, cinnarizine and promethazine?

A

are all H1 antagonists - N&V (prophylaxis & treatment) – particularly motion sickness, vertigo

Adverse effects: Drowsiness, anti-cholinergic effects, tachycardia

Caution: hepatic encephalopathy (sedating effect), prostatic hypertrophy (risk of urinary retention)

Interactions: other sedating or anti-cholinergic drugs may enhance effects

19
Q

prochlorperazine and chlorpromazine are both phenothiazines. What are their MoA and indications for Rx?

A

Block D2 in Chemoreceptor Trigger Zone & gut, H1 antagonists and Ach musc. as above

TF good for:

  • N&V (prophylaxis & treatment) –& vertigo but SE’s!! (as blocks all the receptors of both D2 antagonists and H1 antagonists)
  • Psychotic disorders (typical antipsychotic)
20
Q

prochlorperazine and chlorpromazine are both phenothiazines what are their adverse effects/CI & interactions?

A

prochlorperazine and chlorpromazine are both phenothiazines that block D2 in the CTZ & gut, H1 and Ach musc.

Adverse effects:

  • Drowsiness, (H1)
  • postural hypotension,
  • extra-pyramidal, (D2)
  • acute dystonic reaction, (D2)
  • tardive dyskinesia, (D2)
  • QT-interval prolongation (D2)

Cautions/interactions:

Caution: severe liver disease (SE’s & hepatotoxicity), prostatic hypertrophy (risk of urinary retention) [H1 antagonists]

Reduce doses in elderly

Interactions: drugs that prolong the QT interval (anti-psychotics, amiodarone, ciprofloxacin, macrolides, quinine, SSRI)

21
Q

Ondansetron and graniestron are 5-HT3 antagonists. What is their mechanism of action and what are they used as Rx for?

A
  • Used for: N&V (prophylaxis & treatment) – general anaesthesia & chemo
    • Block 5-HT3 in CTZ
      • drug-induced nausea
    • & gut (response to emetogenic stimuli)
      • Gut infection, radiotherapy
    • 5HT-3 → vagus nerve → solitary tract nucleus → vomiting centre
    • NOT motion (no 5HT communication between vestibular & vomiting centre)

NB: the receptors in the CTZ TF = D2, H1 and 5HT3

22
Q

 What side effects/cautions/interactions do 5-HT3 antagonists ondansetron, graniestron have?

A
  • Rare
    • Constipation, diarrhoea (gut response) & headache
  • Interactions: drugs that prolong the QT interval
    • (anti-psychotics, quinine, SSRIs, ciprofloxacin, macrolides)
23
Q

What are the 2 types of pain?

A
  1. nociceptive pain - from pain receptors
  2. neuropathic pain - from nerve damage
24
Q

The 2 types of pain are nocieptive pain (pain receptors) and neuropathi pain (nerve damage)

together total pain = physical + psychological + social + spiritual

There are 2 subtypes of nociceptive pain - what are these & their differences in symptoms?

A
  • Somatic -
    1. continuous ache,
    2. tender to pressure,
    3. worse on movement,
    4. localised, dull pain
  • Visceral - (e.g. think period cramps)
    1. cramping,
    2. deep pain,
    3. may be aching/dull,
    4. not usually related to movement
    5. & poorly localised
25
Q

The 2 types of pain are nocieptive pain (pain receptors) and neuropathi pain (nerve damage)

together total pain = physical + psychological + social + spiritual

What are the symptoms of neuropathic pain?

A
  • Burning, stabbing, “electric shock”, shooting
  • Intermittent
  • Not movement related
  • May have allodynia, hyperalgesia, and/or sensory deficit
26
Q

What things should be included in a pain assessment?

A
  • SOCRATES
  • impact on QoL
  • phsychological wellbeing
  • sleep quality
27
Q

What are the first 3 steps of the WHO pain ladder?

A
  • Step 1 -
    • paracetamol +/- NSAIDs (naproxen, diclofenac)
  • Step 2 -
    • codeine, tramadol (cognitive SE’s e.g. delirium)
  • Step 3 -
    • fentanyl, buprenorphine, morphine, diamorphine, oxycodone, methadone, alfentanil
28
Q

The WHO pain ladder also reccomends beyond the 3 steps to use adjuvants.

What are these?

A

Adjuvants - work in different ways

  1. Anti-convulsants e.g. Gabapentin, Pregabalin
  2. Antidepressants e.g. Amitriptyline
  3. Bisphosphonates
  4. Steroids
  5. Other treatments e.g. nerve blocks, radiotherapy,
29
Q

What non-pharmacological approaches are there for pain?

A
  • Trans-cutaneous electrical nerve stimulation (TENS)
  • Complementary therapy e.g. massage
  • Counselling
  • Relaxation techniques
  • Spiritual support
30
Q

What is the first line strong opioid for most patients with normal renal function?

A

can be –> oral or IV

Two methods of oral administration:

  • Immediate release (e.g. Oramorph liquid, Sevredol tablets): duration of action 4 hours
  • Modified release capsules (e.g. Zomorph) or tablets (e.g. MST): duration of action 12 hours
31
Q

What other strong, injectable opioids are there?

A
  • Oxycodone (modified or immediate release, injectable)
  • Alfentanil (injectable)
  • Diamorphine (injectable)
32
Q

What transdermal patches are there for pain?

When should they not be used?

A

avoid transdermal if pain is unstable

  • Buprenorphine:
    • e.g. Butrans (change every 7 days),
    • Transtec (change every 96 hours)
  • Fentanyl:
    • change every 72 hours

Both Buprenorphine and Fentanyl are significantly more potent than Morphine (100:1)

33
Q

What are the legal requirements when prescribing controlled drugs?

A
  1. Legible capital letters, indelible ink
  2. Patient details
  3. Prescriber details
  4. Drug details: formulation, strength (if applicable), dose and frequency, total quantity supplied in words and figures
  5. Eliminate space for additions
34
Q

What is a syringe driver?

A
  • Use of a syringe driver (CSCI) enables continuous subcutaneous delivery of drug(s) over 24 hours
  • They are not limited to end-of-life care and do not signal the ‘terminal phase’
  • Other uses include:
    • intractable nausea/vomiting
    • dysphagia and
    • poor oral absorption
  • Can be a temporary measure
  • Are not restricted to Morphine
35
Q

For morphine dose conversion always convert back to what type whan doing dose conversion

What are the conversions between oral opioids>

A

Calculations - always covert back to oral morphine when doing dose conversions

Morphine - 1

Codeine - 1/10

Tramadol - 1/10

Oxycodone - 2

36
Q

What is the conversion from oral –> subcut morphine?

A

subcut morphine/oxycodone is 2x as potent

Oral –> subcut morphine divide by 2

Oral –> subcut oxycodone divide by 2

37
Q

PRN doses of opioids are available. How are these prescribed vs when should the background opioid dose be reviewed?

A
  • For PRN “as required” opioids –> **Use 1/6th of the total 24hr opioid dose
  • If >3 PRN doses are needed, the background opioid dose should be reviewed

**prescribe a regular LAXATIVE and PRN antiemetic (w opioids!!)

38
Q

What are common initial and common ongoing adverse effects of opioid analgesics?

A

Common initial:

  • N&V,
  • drowsiness,
  • unsteadiness,
  • delirium (confusion)

Common ongoing:

  • Constipation,
  • N&V,
  • dry mouth
39
Q

What are the occasional and rareadverse effects of opioid analgesics?

A

Occasional:

  • sweating,
  • pruritus,
  • hallucinations,
  • myoclonus,
  • urinary retention

Rare:

  • respiratory depression,
  • psychological dependence
40
Q

What cautions are there in opioid analgesics?

A

Organ failure

  • use lower starting doses,
  • longer dose intervals
  • & avoid modified release preparations

Renal impairment

  • use opioids without active metabolites where possible e.g. alfenanil
41
Q

When does opioid toxicity occur?

A

Often precipitated by another clinical event e.g. AKI, sepsis

42
Q

What features do these represent?

  • Drowsiness
  • Confusion
  • Myoclonic jerks
  • Vivid dreams
  • Hallucinations
A

Opioid toxicity!

Respiratory depression: rare with careful Opioid titration and a late sign

Geriatric-Palliative (3 decks)

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