(SYNOPTIC) Palliative Care

Question 1

Define palliative care.

Answer 1

Active holistic care of patients with advanced progressive illness

Question 2

What are some key symptoms experienced by palliative care patients?

Answer 2

• delirium
• depression
• anxiety
• N+V
• constipation
• dysphagia
• dyspnoea
• fatigue
• bedsores
• bone pain
• xerostomia
  ø dry mouth
• anorexia

Question 3

What is the general treatment for neuropathic pain?

Answer 3

Antidepressants

Question 4

What are some drugs commonly used in palliative care that can cause constipation?

Answer 4

• opioids
• iron
• ondansetron
• octreotide

Question 5

What is the treatment for confusion/ agitation in palliative care?

Answer 5

Consider reversible causes

Treat as for delirium

• Benzodiazepines
• antipsychotic

Question 6

What is the first line treatment for N+V due to gastric stasis?

Answer 6

Metoclopramide

Question 7

What is the first line treatment for N+V due to obstruction (no colic)?

Answer 7

Metoclopramide + dexamethasone

Question 8

What is the first line treatment for N+V due to obstruction (with colic)?

Answer 8

Cyclizine + buscopan

Question 9

What is the first line treatment for N+V due to drugs/ biochemical causes?

Answer 9

Haloperidol

Question 10

What is the first line treatment for N+V due to raised intracranial pressure?

Answer 10

Cyclizine + dexamethasone

Question 11

What is the first line treatment for N+V due to radiotherapy?

Answer 11

Ondansetron

Question 12

What is the first line treatment for N+V due to chemotherapy?

Answer 12

Ondansetron

Question 13

What is the first line treatment for N+V due to an uncertain cause?

Answer 13

Haloperidol/ cyclizine

Question 14

What is a common use of levomepromazine in palliative care?

Answer 14

Often used as a 2nd line treatment for nausea and vomiting

Question 15

What is neutropenic sepsis?

Answer 15

Neutrophil count <0.5x10^9 + >38ºC temperature

Medical emergency & can occur in any patient who has received chemotherapy in <4 weeks

Question 16

How is neutropenic sepsis managed?

Answer 16

Broad spectrum ABx IV within 1hr

- tazocin + gentamicin

Question 17

What is the treatment for malignant spinal cord compression?

Answer 17

• dexamethasone
• analgesia
• radiotherapy
• surgery

Question 18

What is the treatment of malignant hypercalcaemia?

Answer 18

• Fluid replacement
• bisphosphonates
  ø zolendronate
  ø pamidronate

Question 19

What are some symptoms that can be expected in a patient’s late/ last days (end of life)?

Answer 19

• agitation
• decreased level of consciousness
• mottled skin
• noisy respiratory secretions
• cheyne-stokes breathing

Question 20

What is the purpose of using syringe drivers?

Answer 20

Used SC to give a steady plasma concentration of a drug

Useful when a patient is too weak to swallow drugs/ unconscious

Question 21

How can postural hypertension be resolved pharmacologically?

Answer 21

Midodrine + fludrocortisone

AVOID fludrocortisone in heart failure