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Palliative Care > Symptomatic Management > Flashcards

Symptomatic Management Flashcards

1
Q

Indications of depression in a long term illness

A

Complete/absaloute anhedonia
Suicidal ideation
Inappropriate guilt

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2
Q

Treatment of depression in palliative care and what type of treatments are these?

A

Methylphenedate/amphetamine
ECT
Immediate treatments for depression

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3
Q

Types of pain

A

Nociceptive
Neuropathic
Visceral
Incident

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4
Q

What is a hollow viscera?

A

Tubes surrounded by muscles (peristalsis)

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5
Q

Pathology of neuropathic pain

A

Damaged nerves

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6
Q

Features of visceral pain

A

Colic
Classic crescendo decrescendo pain
Midline
Poorly localised

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7
Q

Examples of hollow viscera organs

A 
Gut 
Biliary tree
Bladder
Uterus 
Fallopian tubes
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8
Q

Features of incident pain

A

No pain to very sore to no pain
Associated with procedures, weight bearing
A trigger; when taken away the pain goes as well

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9
Q

What types of pain can incident pain be?

A

Nociceptive
Neuropathic
Visceral

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10
Q

What is the best symptom control?

A

Treating the underlying cause (if possible and appropriate)

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11
Q

What to ask in a pain history?

A 
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?
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12
Q

A patient with metastatic cancer will have a median of how many pains?

A

3

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13
Q

WHO pain ladder

A 
Step 1 - mild pain
- NSAIDs
- Paracetamol 
- +/- adjuvants 
Step 2 - moderate pain 
- Mild opiates 
- + step 1 
Step 3 - severe pain 
- Strong opioid 
- + step 1
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14
Q

Examples of mild opiates

A

Codeine
Dihydrocodeine
Tramadol

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15
Q

How much of cancer pain can be controlled by the WHO pain ladder?

A

80% +

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16
Q

What does adjuvant mean?

A

A treatment that helps pain that is not an analgesic

17
Q

What do steroids reduce?

A

Oedema

18
Q

What is codeine turned into in the body?

A

Morphine

19
Q

60mg of codeine 4x per day is the equivalent to how much oral morphine?

A

60mg x 4 / 10 => 24 mg of oral morphine per day

20
Q

What are the strong opioids?

A 
Morphine
Fentanyl 
Penthidine 
Methadone
Diamorphine
Oxycodone 
Bupaenorphine
Hydromorphone
21
Q

S/Es of morphine

A

Resp depression in IV use when quick rate of change
Constipation
Drowsy
Nausea

22
Q

Regular prescription of morphine needs prescribed with what?

A

A laxative

23
Q

What can happen to nausea and vomiting side effects of morphine?

A

You can become tolerant and they can disappear

24
Q

What is morphine MST?

A

Modified release

25
Q

What is modified release morphine?

A

Morphine which releases over 12 hours so 2x a day

26
Q

What is oramorph (secudol)?

A

Oral morphine immediate release

27
Q

How do you work out the oramorph dose?

A

Total daily dose of morphine / 6

Rounded to 5mg for a tablet as required for pain

28
Q

What is breakthrough pain?

A

Episodes of pain that break through despite background medication

29
Q

What must be done if oramorphine is required?

A

Change the MST dose as they need more

Then have to increase the breakthrough dose

30
Q

What must be investigated if the patient is confused?

A

Causes of their confusion e.g. hypercalcaemia, infection, urinary retention, medication

31
Q

Treatment of agitation/confusion

A

Haloperidol
Also
- chlorpromazine
- levomepromazine

32
Q

What is haloperidol contraindicated in?

A

PD

33
Q

In the terminal phase of illness, agitation or restlessness is best treated with what?

A

Midazolam

34
Q

Treatment of hiccups

A

Chlorpromazine (intractable hiccups)
Haloperidol
Gabapentin
Dexamethasone if hepatic lesions

35
Q

What symptom is common in the last days of life?

A

Secretions

36
Q

Treatment of secretions

A

Avoid fluid overload (stop IV or subcut fluids)
1st line - hyoscine butylbromide
2nd line - glycopyrronium bromide

Palliative Care (3 decks)

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