Symptomatic Management Flashcards
Indications of depression in a long term illness
Complete/absaloute anhedonia
Suicidal ideation
Inappropriate guilt
Treatment of depression in palliative care and what type of treatments are these?
Methylphenedate/amphetamine
ECT
Immediate treatments for depression
Types of pain
Nociceptive
Neuropathic
Visceral
Incident
What is a hollow viscera?
Tubes surrounded by muscles (peristalsis)
Pathology of neuropathic pain
Damaged nerves
Features of visceral pain
Colic
Classic crescendo decrescendo pain
Midline
Poorly localised
Examples of hollow viscera organs
Gut Biliary tree Bladder Uterus Fallopian tubes
Features of incident pain
No pain to very sore to no pain
Associated with procedures, weight bearing
A trigger; when taken away the pain goes as well
What types of pain can incident pain be?
Nociceptive
Neuropathic
Visceral
What is the best symptom control?
Treating the underlying cause (if possible and appropriate)
What to ask in a pain history?
SOCRATES Type Cause Impact - mood - activities - sleep Meaning - what are they scared of? - what does the pain mean to them? - what are they hoping for?
A patient with metastatic cancer will have a median of how many pains?
3
WHO pain ladder
Step 1 - mild pain - NSAIDs - Paracetamol - +/- adjuvants Step 2 - moderate pain - Mild opiates - + step 1 Step 3 - severe pain - Strong opioid - + step 1
Examples of mild opiates
Codeine
Dihydrocodeine
Tramadol
How much of cancer pain can be controlled by the WHO pain ladder?
80% +
What does adjuvant mean?
A treatment that helps pain that is not an analgesic
What do steroids reduce?
Oedema
What is codeine turned into in the body?
Morphine
60mg of codeine 4x per day is the equivalent to how much oral morphine?
60mg x 4 / 10 => 24 mg of oral morphine per day
What are the strong opioids?
Morphine Fentanyl Penthidine Methadone Diamorphine Oxycodone Bupaenorphine Hydromorphone
S/Es of morphine
Resp depression in IV use when quick rate of change
Constipation
Drowsy
Nausea
Regular prescription of morphine needs prescribed with what?
A laxative
What can happen to nausea and vomiting side effects of morphine?
You can become tolerant and they can disappear
What is morphine MST?
Modified release
What is modified release morphine?
Morphine which releases over 12 hours so 2x a day
What is oramorph (secudol)?
Oral morphine immediate release
How do you work out the oramorph dose?
Total daily dose of morphine / 6
Rounded to 5mg for a tablet as required for pain
What is breakthrough pain?
Episodes of pain that break through despite background medication
What must be done if oramorphine is required?
Change the MST dose as they need more
Then have to increase the breakthrough dose
What must be investigated if the patient is confused?
Causes of their confusion e.g. hypercalcaemia, infection, urinary retention, medication
Treatment of agitation/confusion
Haloperidol
Also
- chlorpromazine
- levomepromazine
What is haloperidol contraindicated in?
PD
In the terminal phase of illness, agitation or restlessness is best treated with what?
Midazolam
Treatment of hiccups
Chlorpromazine (intractable hiccups)
Haloperidol
Gabapentin
Dexamethasone if hepatic lesions
What symptom is common in the last days of life?
Secretions
Treatment of secretions
Avoid fluid overload (stop IV or subcut fluids)
1st line - hyoscine butylbromide
2nd line - glycopyrronium bromide
