Palliative Care Flashcards

1
Q

what is pain management for mild pain (step 1)?

A

paracetamol 1g 4x daily

and/or NSAID eg naproxen 500mg 2x daily

and/or other adjuvant

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2
Q

what is pain management for moderate pain (step 2)?

A

codeine 30-60mg 4x daily

or cocodomal 50/500, 2 tablets 4x daily

and/or adjuvant

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3
Q

what is pain management for severe pain (step 3)?

A

stop codeine and switch to strong opioid - usually morphine

can use in conjunction with paracetamol / NSAID

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4
Q

how should morphine for background pain be administered?

A

modified release (MR)

twice daily tablet
MST or zoromorph

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5
Q

how should morphine for breakthrough pain be administered?

A

immediate release (IR)

PRN tablet (sevredol) or liquid (oramorph) which is approx 1/6 of total background dose

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6
Q

those on morphine do not become opioid tolerant - true or false?

A

false - they will get withdrawal if it is suddenly stopped

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7
Q

what are the symptoms of opioid toxicity?

A

hallucinations
myoclonus
drowsiness

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8
Q

what do patients with opioid toxicity usually respond to?

A

dose adjustment / switching to another strong opioid

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9
Q

what should you check the function of when opioid toxicity occurs?

A

renal function - if it is impaired then morphine will accumulate as it is renally excreted

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10
Q

what is the severe side effect of morphine which only occurs rarely when used it is correctly?

A

respiratory distress

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11
Q

what can reverse morphine very quickly?

A

naloxene

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12
Q

which opioid is twice as strong as morphine?

A

oxycodone

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13
Q

SCUT morphine is how much stronger than oral?

A

twice - so divide dose by 2

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14
Q

name 5 treatable conditions which can mimic dying?

A
opioid / drug toxicity 
sepsis 
hypercalcaemia 
AKI
hypoglycaemia
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15
Q

which medications should be continued during end of life care?

A

only essential ones (stop statins and anticoagulants)

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16
Q

what are syringe drivers?

A

butterfly needle with connector tubing which can mix up to 3 medications which are infused over 24 hours

17
Q

are syringe drivers portable?

A

yes - used in hospital or community

18
Q

what kind of medication is prescribed for common problems during end of life care?

A

anticipatory

19
Q

what should you keep in mind as cause of agitation during end of life care?

A

urinary retention

20
Q

what should be anticipatory prescribed for pain / SOB during end of life care?

A

morphine 2mg scut hourly

21
Q

what should be anticipatory prescribed for distress during end of life care?

A

midazolam 2mg scut hourly

22
Q

what should be anticipatory prescribed for nausea during end of life care?

A

levomepromazine 2.5mg scut twelve hourly

23
Q

what should be anticipatory prescribed for secretions during end of life care?

A

buscopan 20mg scut hourly

24
Q

since people become too weak to swallow food or water in final days of life, what is essential?

A

meticulous mouth care

25
Q

should IV fluids be used in end of life care?

A

no - burdensome for patients and high risk

can give trial of artificial hydration if patient distressed due to thirst / dehydration despite mouth care

26
Q

what 5 things should you do to verify death?

A

check for spontaneous movement inc respiratory effort

check for reaction to voice and pain

palpate at least 2 major pulses for one minute

inspect eyes for dryness, fixed dilated pupils, absence of corneal reflexes and clouding of cornea

auscultate heart and lungs for one minute

27
Q

what should you remember to note the presence of when verifying death?

A

pacemaker or other implantable device