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PHAM02 > Wk 17: Palliative care > Flashcards

Wk 17: Palliative care Flashcards

1
Q

What are the signs that a patient is dying?

A
  • Bed bound + profound weakness
  • Red consciousness
  • Sips of fluid
  • Unable/difficulty taking oral meds
  • Deteriorating day by day
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2
Q

What are the rules when reviewing regular medication?

A
  • Non-essential drugs: discontinued
  • Essential oral drugs (analgesics, antiemetics, anticonvulsants + steroids: SC or CSCI
  • PRN: prescribed for anticipated symptoms SC
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3
Q

When should PRN sc meds be prescribed?

A
  • Pain
  • Agitation/restlessness
  • Respiratory tract secretions
  • Nausea/vom
  • Breathlessness
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4
Q

What do you give if the patient is not on regular analgesia and are currently pain free?

A

Morphine injection 2.5mg-5mg prn upto hourly sc

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5
Q

What do you give if the patient is not on regular analgesia and are currently in pain?

A

Morphine injection 2.5mg stat sc

Effective: morphine injection 10mg sc over 24 hrs CSCI + prn morphine

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6
Q

How do you use the syringe driver?

A
  • Mix w/ water or 0.9% sodium chloride
  • Irritation to skin = add dexamethasone
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7
Q

How would you give longer acting drugs?

A

STAT sc (haloperidol + levomepromazine)

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8
Q

When would you use oxycodone?

A
  • Mod-severe pain
  • If morphine not tolerated
  • Caution pain w/ renal impairment
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9
Q

What do you do when you convert from PO to SC?

A

Half 24hr dose

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10
Q

When would you use alfentanil?

A
  • Severe renal impairment
  • V short half life tf only use in CSCI
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11
Q

Define allodynia

A

Pain due to stimulus which wouldn’t usually provoke pain (eg. light touch)

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12
Q

Define hyperalgesia

A

Increased response to stimulus which is normally painful

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13
Q

What are the side effects of normal therapeutic level opioids?

A
  • Constipation
  • Nausea
  • Urinary retention
  • Itch/rash
  • Dry mouth
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14
Q

What are the side effects of high therapeutic level opioids?

A
  • Hallucinations
  • Abnormal skin sensitivity
  • Sedation
  • Respiratory depression
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15
Q

What is the neuropathic pain ladder?

A
  1. Steroid
  2. Antidepressant
  3. Anticonvulsant
  4. NMDA antagonist
  5. Spinal analgesia
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16
Q

What are the reasons why patients experience nausea + vomiting?

A
  • Opioids
  • Hypercalcaemia (bone metastases)
  • Liver failure
  • Raised intracranial pressure
  • Brain metastases
17
Q

If a patient was already on a regular anti-emetic, how could you optimize their therapy?

A

Sc or CSCI

18
Q

Which anti-emetic can’t be given by injection?

A

Domperidone tf convert to metoclopromide

19
Q

What do you give if the nausea + vomiting is metabolic, infective or drug induced?

A

Haloperidol - 0.5-1.5mg sc hourly prn (max 3mg)

20
Q

What do you give if the nausea + vomiting is for bowel distension/obstruction, vestibular problems or raised intracranial pressure?

A

Cyclizine - 50mg sc hourly (max 150mg)

21
Q

What do you give if the nausea + vomiting is for bowel distension/obstruction, vestibular problems or raised intracranial pressure but the patient has severe HF or renal failure?

A
  • Haloperidol or levomepromazine
  • No cyclizine - tachycardia
22
Q

What do you do for nausea + vomiting at the end of life (gastric stasis - large vol vomit, hiccups + belching)?

A
  • Check over feeding: PEG red or stop + stop IV/SC fluids
  • Oral metoclopramide: switch to sc or discontinue
23
Q

What must you not give if vomiting due to bowel obstruction?

A

Metoclopramide bc prokinetic

24
Q

What do you give if a patient isn’t responding to antiemetic?

A

Levomepromazine (sedating) - 5mg/6.26 sc prn hourly (max 25mg)

25
Q

What is terminal agitation?

A

Agitation that occurs in last few days of life

26
Q

What are the causes of agitation?

A
  • Meds
  • Pain
  • Nausea
  • Emotional distress
27
Q

What do you give for terminal agitation?

A

Midazolam - 2.5-5mg sc PRN hourly

Responds: CSCI 10mg sc/24hrs

28
Q

What do you give if the patients agitation doesn’t settle after giving highest dose of midazolam?

A

Levomepromazine - 6.25mg/12.5mg sc prn

Responds: CSCI or stat dose

29
Q

What do you give if a patient has respiratory tract secretions?

A
  • Reposition
  • Hyoscine hydrobromide - 100mcg prn hrly, CSCI 1200mcg/24hrs
  • Sedative
30
Q

What do you give if a patient has respiratory tract secretions + renal failure?

A

Hyoscine butylbromide (non-sedating)
- 20mg sc PRN (120mg max)

  • CSCI: 60mg/24hrs
31
Q

What other reasons other than respiratory tract secretion, would you give hyoscine butylbromide?

A

Bowel colic/bladder spasm

32
Q

If a patient has secretions despite hyoscine HB/BB, what would you prescribe?

A

Glycopyrronium - 200mcg sc prn hourly

CSCI: 600/1200mcg/24hrs

33
Q

What do you prescribe a patient with breathlessness?

A

Opioid - 2.5mg-5mg sc upto hourly prn

34
Q

What do you prescribe a patient with breathlessness who is already on opioids?

A

Midazolam - 2.5mg-5mg sc upto hourly prn

  • 2/more doses needed, add to syringe driver

PHAM02 (35 decks)

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