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Flashcards in Palliative prescribing Deck (31):
1

Name 2 opioids for moderate pain

Codeine phosphate
Tramadol hydrochloride

2

Name 5 opioids for severe pain

Morphine
Buprenorphine
Oxycodone
Methadone
Fentanyl

3

Adjuvant treatment of pain due to bone mets

Radiotherapy
Bisphosphonates
Strontium Ranelate

4

Name the first line medications for neuropathic pain

Amitriptyline, nortriptyline (TCAs)
Carbamazepine for trigeminal neuralgia

5

2nd line for neuropathic pain

Anti-epileptics (pregabalin, gabapentin, carbamazepine)

6

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

Tramadol
Use while waiting for a specialist review

7

What can be used for post-herpetic neuralgia?

Capsaicin cream or patch

8

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

Prednisolone, reduced swelling and compression
Radiotherapy if spinal cord compression

9

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

Immediate release oral morphine

10

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

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

What should be prescribed with morphine

Laxative (senna, lactulose, methylnaltrexone bromide)
Anti-emetic for first 3 days (haloperidol/metoclopramide)

12

Which analgesia can be given transdermally?

Fentanyl
Buprenorphine

13

What can help with anorexia and dysphagia?

Prednisolone
Dexamethasone

14

What can be given for excessive respiratory secretions?

Hyoscine butylbromide (buscopan)
Glycoperonium bromide

15

3 options for capillary bleeding associated with liver failure

Tranexamic acid
Topical adrenaline
Vit K

16

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

Phenytoin
Carbamazepine
or rectal diazepam

17

Treatment of dry mouth

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

18

Management of oral candida

Oral nystatin, fluconazole

19

Management of fungating tumours

Metronidazole
Regular dressings

20

Management of hiccup

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

21

Management of intractable cough

Moist inhalations
Morphine
(avoid methadone linctus)

22

Management of muscle spasm

Diazepam
Baclofen (muscle relaxant)

23

When is cyclizine used?

Raised IVP
Motion sickness
Mechanical bowel obstruction

24

Itching with obstructive jaundice

Emollients
2nd line: colestyramine

25

Management of restlessness and insomnia

Levomapromazine
Haloperidol
Midazolam

26

Name 6 signs of opioid toxicity

Myoclonic jerks
Agitation
Hallucinations
Confusion
Pin point pupils
Respiratory depression

27

Which anti-emetics work well for gut problems?

Dopamine antagonists, work outside BBB
Domperidone
Also prokinetic

28

Which antiemetic works well for chemical causes of nausea?

Haloperidol low dose
Works at CTZ

29

Which antiemetic is useful in bowel obstruction?

Cyclizine
Not prokinetic

30

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

Opioids
Benzodiazepines

31

Management of hypercalcaemia?

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