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Pharm301 Topics > Topic 5: palliative care > Flashcards

Topic 5: palliative care Flashcards

1
Q

What is palliative care?

A
  • active total care of patients whos disease is not responsive to curative treatment
  • it doesn’t hasten or postpone death, but allows those involved in the care of patients to relieve pain and other symptoms in an environment of the patients choice.
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2
Q

Who is part of providing palliative care?

A
  • patient
  • family and friends
  • GPs
  • pharmacists
  • oncology district nurses
  • hospice nurses
  • hospice doctors
  • others as needed
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3
Q

What is the pharmacists’ role in palliative care?

A
  • liaise with all prescribers, nurses and other treatment providers to ensure that medications match symptoms
  • liaise with patients and family and friends to ensure their concerns are taken into account
  • advise GPs as to dose conversions from oral to parenteral
  • managing total medication needs
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4
Q

What are we trying to alleviate in palliative care?

A
  • pain
  • alimentary symptoms
  • respiratory symptoms
  • psychological symptoms
  • biochemical symptoms
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5
Q

How is pain managed?

A

-by moving along the WHO pain ladder as pain needs increase or cease to be well controlled by existing medications

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6
Q

What can NSAIDs and paracetamol mask and therefore require care?

A

these can suppress temperatures and mask signs of infection

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7
Q

What are the types of pain?

A

nocioceptor - deep or aching

neuropathic - burning, shooting or stabbing pain

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8
Q

How is pain assessed?

A
  • be aware that not all pain is due to cancer
  • rule out pain due to pre-existing conditions such as osteoarthritis
  • ask what makes the pain worse or better
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9
Q

How is pain diagnosed?

A
  • asking about symptoms

- knowing the causes of pain

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10
Q

What are simple analgesics?

A

step 1 of the WHO ladder:

Paracetamol or NSAIDs

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11
Q

What is step 2 of the analgesic ladder?

A

paracetamol or NSAIDs PLUS weak opiods

e.g. paracetamol + codine or ibuprofen + codeine

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12
Q

What is step 3 of the analgesic ladder?

A

REGULAR paracetamol or NSAIDS plus strong opiod

e.g. paracetamol + morphine
Paracetamol + methadone
paracetamol + oxycodone

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13
Q

What happens if pain decreases?

A

you should go back down the ladder because pain prevents the central depressant effects of opiods

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14
Q

What are examples of co-analgesics or adjuvant analgesics?

A

corticosteroids like dexamethasone

antidepressants & anti-epileptics like amitriptyline and valproate

antipasmodics like buscopan (hyocsine N-butyl bromide

Muscle relaxants like diazepam

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15
Q

What types of analgesics treat organ or soft tissue pain?

A
  • paracetamol + codine
  • oral morphine
  • parenteral morphine
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16
Q

What types of analgaesics treat bone pain?

A

NSAIDs and morphine

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17
Q

What types of analgesics treat nerve pain?

A
  • valproate
  • carbamazepine
  • gabapentin
  • ketamine
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18
Q

What sort of analgesics treat headache from intracranial pressure?

A

dexamethasone

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19
Q

What type of analgesics treat pain from GI obstruction?

A

Hyoscine N-butylbromide (buscopan)

20
Q

How is incident or breakthrough pain managed?

A
  • give rapid onset opioid such as morphine elixir
  • aim of treatment is to give appropriate analgesia to control chronic pain and treat break through pain with rapid acting opioids
21
Q

What are the causes of nausea?

A

chemoreceptor trigger zone stimulation

vomiting centre stimulation

vagal stimulation

vestibular stimulation

22
Q

What are the causes of pain?

A 
constipation
GI blockage
tumour growth
unresolved issues about death and dying 
incident pain
23
Q

How is CTZ induced vomiting treated?

A

1st line: haloperidol

2nd line: levomepromazine

24
Q

How is vomiting centre induced nausea treated?

A

1st line: cyclizine

2nd line: dexamethasone

25
Q

What causes vomiting centre induced nausea?

A

radiotherapy

intracranial pressure

26
Q

How is vagal stimulation e.g. cough, obstruction, constipation treated?

A

cough: treat normally
gastric stasis: metoclopramide or domperidone
internal obstruction: cyclizine

27
Q

How is vestibular motion (motion movement) nausea treated?

A

1st line: cyclizine

2nd line: hyoscine patch

28
Q

What is constipation?

A
  • reduced bowel movements
  • bowel may be too hard, too painful
  • patient may be going too infrequently
29
Q

In which patients is constipation common in?

A

Those receiving opiod treatment including mild opiates such as codeine

30
Q

What else can constipation be caused by?

A

less food
less exercise
less fluid
more drugs

31
Q

What is the treatment for constipation?

A

lots of laxatives

32
Q

What are the sorts of laxatives used in palliative constipation?

A
  • increase fibre and fluid in diet in early stages
  • as it progresses, opiate induced constipation becomes overriding concern and needs to be addressed with stimulants rather than bulk forming agents
33
Q

which laxatives should be avoided?

A

osmotic laxatives like lactulose

34
Q

What are the respiratory symptoms commonly encountered in palliative care?

A

breathlessness
cough
hiccough
death rattle

35
Q

What is breathlessness dependent on?

A

emotional state of patient

36
Q

What are the causes of breathlessness?

A

-complex, but generally progressive: from breathlessness on exertion to at rest, to terminal breathlessness

37
Q

How is breathlessness treated?

A

-with reassurance, positioning and eventually, morphine if not previously used

38
Q

What causes hiccups?

A

gastric distension

39
Q

How can hiccups be treated?

A
  • encourage belching
  • peppermints are useful
  • may use haloperidol or midazolam for diaphragm irritation
40
Q

What causes death rattle?

A

secretions in pharynx

rattling sound is caused by patient being too weak to cough these out

41
Q

How is death rattle treated?

A

with hyoscine hydrobromide (not buscopan)

42
Q

What are some psychological problems encountered in palliative care?

A
  • depression
  • denial
  • anger
  • anxiety
43
Q

What are the biochemical symptoms?

A

hypercalcaemia - caused by increased bone metabolism and decreased renal clearance

44
Q

How is hypercalcaemia treated?

A

-rehydration and steroids

bisphosphonates if severe

45
Q

What important responsibilities do heath professionals face in the last few days?

A
  • communicate openly about what and when is happening, address and concerns
  • make sure they know who to contact in the event of ‘something going wrong’

Pharm301 Topics (8 decks)

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