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Flashcards in Palliative Care Deck (28)
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1

What is Palliative Care?

The active total care of patients whose disease is not responsive to curative treatment

 

The goal is the achievement of the best quality of life for the patient and their family

2

What are the disease trajectories for the following diseases?

 

Cancer

Heart/Lung Faliure

Frailty/Dementia

Left = Cancer

 

Middle = Heart/Lung Faliure

 

Right = Frailty/Dementia

3

In terms of symptom control, what does the acronym IMPACT stand for?

Identify concerns

Make an accurate assessment

Plan your action

Act

Consistnetly re-evaluate

Talk to other HCPs

4

What are some of the ways that we can assess patients pain?

Pain Scale

 

Visually looking --> Do they look in pain?

 

Questionnaires

 

Types of pain

 

History of pain --> If theres a history then they're more likely to score it lower as they're used to it! And visa versa

5

When prescribing strong opioids, what else do we need to manage?

Constipation --> 90% of patients get it, so prescribe laxatives

 

Nausea --> Most people will be nauseous, but will often stop after 4-5 days...so anticipatory prescribing isnt always required

 

Drowsiness --> Common when starting strong opioids, but normally transient

6

What is opioid rotation?

A switch from one type of opioid to another to get a batter balance between the analgesia and the side effects

 

- Evidence for and against this being clincially useful

7

How are opioid conversions done?

Calculate the 24hr requirments

Convert back to oral morphine

Convert to new opioid to work out the new dose

Work out BCP dose

8

Why does Fentanyl cause less constipation than Morphine?

As Fentanyl can pass into the CNS easier, and so less is present in the periphery....so less can bind to peripheral receptors and cause constipation

9

What can be used for BCP when using Fentanyl as the SR opioid?

Fentanyl Lozenges or Sublingual

 

Alifentanil Sublingual or Spray

 

 

10

When would Hydromorphone be used?

If side effects of normal morphine are intolerable

 

In renal faliure, due to only having one active metabolite....so it is more readily excreted and glucoronidated

11

What is the main difference between Oxycodone and Morphine?

Oxycodone has slight Kappa agonist activity

12

What are the positives and negatives of methadone use for pain?

Positives --> Long-half and NMDA activity means it can be used for neuropathic pain

 

Negatives --> Long-half life makes titration very difficult, Sc infusion can be irritating

 

13

What type of Bone Targeting Agents (BTAs) can be used for bone pain?

Bisphosphonates

 

Strontium Ranelate

 

Denosumab

14

What is Allodynia?

Having hypersensitive nerve endings....so you feel pain for no real reason

15

How could we help treat neuropathic pain?

NOT with opioids!!

 

Dexamethasone --> Shrink tumours if they are pushing on nerves

 

Antidepressents --> Promote inhibitory pain pathways

 

AEDs --> Activate pain suppression pathways

 

Gabapentin --> Increases GABA (inhibitory) synthesis in the CNS

 

Ketamine --> NMDA antagonist in the spine that can be given in high doses

- Must be prescribed with diazepam or midazolam

16

Explain the functions of the following anti-emetics

 

Metoclopromide

Cyclizine

Haloperidol

Metoclopromide --> D2 antagonist, so best for gastritis by increasing peristalsis

 

Cyclizine --> Targets the vomiting centre, so best for motion sickness

 

Haloperidol --> Targets the CTZ, so best for chemcial related N+V

17

Explain the functions of the following anti-emetics

 

Levomepromazine

Hyoscine Butylbromide

Octreotide

Levomepromazine --> Broad acting anti-emetic, that can also be used for agitation

 

Hyoscine Butylbromide --> Works only on the muscarinic receptors, and so best for reducing GI motility

 

Octerotide --> Somatastain analogue that can be mixed with morphine

18

Explain the functions of the following anti-emetics

 

Ondansetron

Dexamethasone

Aprepitant

Ondansetron --> Specific to 5HT3, so not often used in palliative care

 

Dexamethasone --> An adjuvant anti-emetic in bowel obstruction

 

Aprepitant --> An NK1 antagonist

19

What was the Liverpool Care Pathway?

A pathway that was designed to ensure that all patients got the same end of life care regardless of where they were living

 

Was not followed correctly, and so replaced with NICE Guideline 31

20

What is Antcipatory Prescribing?

Prescribing in advance to allow easy access to drugs quickly in the community , especially when the patient deteriorates out of hours

 

Most effective when the GP has been caring for the patient for a prolonged period of time, as they will understand what is likely to be an issue (eg, N+V or constipation over other things prehaps

21

What is the first line drug for patients with excess secretions/colic?

Hyoscine Butylbromide

22

What are the symptoms and treatments of Hypercalcemia of Malignancy?

Dehydration, N+V, constipation, fatigue, confusion, cardiac complications and myopathy

 

Treatment --> Rehydratrion and bisphosphonates

23

What do you give STAT is there are symptoms of spinal cord compression?

16mg Dexamethasone

24

What is the conversion of prednisolone to dexamethasone?

6mg Prednisolone = 1mg Dexamethasone

25

Why may a patient need a syringe driver?

NBM

 

Unconscious/Weak

 

Lots of N+V

26

In what pHs is diamorphine less stable?

Higher pHs (more alkaline)

27

Why is using clonazepam in a syringe driver problematic?

As it no longer licenced as a solution for injection

 

So either cant be given, or needs to be ordered as a special

28

What should you be thinking about when prescribing anticipatory medicines?

Likelyhood of the specific symptoms occur

 

Benefits and harms of giving the drugs/not giving them

 

The risk of sudden deterioration

 

The place that care is occuring, and so the time it'll take to get the drugs