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Flashcards in Palliative prescribing Deck (31)
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1
Q

Name 2 opioids for moderate pain

A

Codeine phosphate

Tramadol hydrochloride

2
Q

Name 5 opioids for severe pain

A
Morphine
Buprenorphine
Oxycodone
Methadone
Fentanyl
3
Q

Adjuvant treatment of pain due to bone mets

A

Radiotherapy
Bisphosphonates
Strontium Ranelate

4
Q

Name the first line medications for neuropathic pain

A

Amitriptyline, nortriptyline (TCAs)

Carbamazepine for trigeminal neuralgia

5
Q

2nd line for neuropathic pain

A

Anti-epileptics (pregabalin, gabapentin, carbamazepine)

6
Q

If neuropathic pain not relieved by TCAs or antiepileptics, what can be used?

A

Tramadol

Use while waiting for a specialist review

7
Q

What can be used for post-herpetic neuralgia?

A

Capsaicin cream or patch

8
Q

What can be used to treat neuropathic pain caused by compression?

A

Prednisolone, reduced swelling and compression

Radiotherapy if spinal cord compression

9
Q

What should be given for breakthrough pain when a pt is taking modified release oral morphine?

A

Immediate release oral morphine

10
Q

If the dose of morphine is not covering the pain, what can be done?

A

Calculate how many rescue doses were taken in a 24hr period and increase the 24hr total dose by that much
Or, increase the dose by 1/3

11
Q

What should be prescribed with morphine

A

Laxative (senna, lactulose, methylnaltrexone bromide)

Anti-emetic for first 3 days (haloperidol/metoclopramide)

12
Q

Which analgesia can be given transdermally?

A

Fentanyl

Buprenorphine

13
Q

What can help with anorexia and dysphagia?

A

Prednisolone

Dexamethasone

14
Q

What can be given for excessive respiratory secretions?

A
Hyoscine butylbromide (buscopan)
Glycoperonium bromide
15
Q

3 options for capillary bleeding associated with liver failure

A

Tranexamic acid
Topical adrenaline
Vit K

16
Q

What can be used prophylactically to prevent convulsion in pts with cerebral tumours or uraemia?

A

Phenytoin
Carbamazepine
or rectal diazepam

17
Q

Treatment of dry mouth

A

Good mouth care
Sugar free gum
Sucking ice or pineapple chunks
Artificial saliva

18
Q

Management of oral candida

A

Oral nystatin, fluconazole

19
Q

Management of fungating tumours

A

Metronidazole

Regular dressings

20
Q

Management of hiccup

A

Anti flatulant medicines (simeticone? asoefoetida?)
+ antacid (aluminium hydroxide)
2nd line: metoclopamide
2rd line: baclofen, nifedipine

21
Q

Management of intractable cough

A

Moist inhalations
Morphine
(avoid methadone linctus)

22
Q

Management of muscle spasm

A

Diazepam

Baclofen (muscle relaxant)

23
Q

When is cyclizine used?

A

Raised IVP
Motion sickness
Mechanical bowel obstruction

24
Q

Itching with obstructive jaundice

A

Emollients

2nd line: colestyramine

25
Q

Management of restlessness and insomnia

A

Levomapromazine
Haloperidol
Midazolam

26
Q

Name 6 signs of opioid toxicity

A
Myoclonic jerks
Agitation
Hallucinations
Confusion
Pin point pupils
Respiratory depression
27
Q

Which anti-emetics work well for gut problems?

A

Dopamine antagonists, work outside BBB
Domperidone
Also prokinetic

28
Q

Which antiemetic works well for chemical causes of nausea?

A

Haloperidol low dose

Works at CTZ

29
Q

Which antiemetic is useful in bowel obstruction?

A

Cyclizine

Not prokinetic

30
Q

How do you treat breathlessness in end-of-life pts?

A

Opioids

Benzodiazepines

31
Q

Management of hypercalcaemia?

A

Check calcium, renal function, albumin
Rehydrate (minimum 2L)
Bisphosphonates