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Cancer > 6.7b Palliation - Symptom Management > Flashcards

6.7b Palliation - Symptom Management Flashcards

1
Q

Which symptoms are very commonly present in patients requiring palliative care?

A
  • Pain
  • Nausea and Vomiting
  • Diarrhoea
  • Constipation
  • Lost appetite
  • Breathlessness
  • Insomnia
  • Fatigue
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2
Q

What dose NHS ENgland suggest are the 4 basic principles of good symptom management during palliative care

A
  • Evaluate – ID cause
  • Explain – Explain what has happened
  • Manage – Explain options and treat
  • Monitor – Monitor progress
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3
Q

What is pain?

A
  • An unpleasant, sensory and emotional experience associated with actual or potential tissue damage
  • From a patients perspective….Pain is what the patient says hurts…
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4
Q

What are 5 principles of pain management?

A

ID Cause to optimise Tx →

Start at the right point on WHO pain ladder →

Oral Tx preferred→

Pain charts give baseline →

Pts play active role

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5
Q

What are the 3 stepps on the WHO pain ladder?

A

Step 1

* Paracetamol 1g QDS PO then

* Paracetamol 1g QDS + NSAID e.g. Naproxen 500mg BD

Step 2

* Paracetamol + NSAID then

* Week opioids e.g. Codeine
	○ In combo with Laxatives as it can cause constipation
	
* With or without paracetamol if required

Step 3

* Strong opioids for pain e.g. Morphine, Diamorphine and Fentanyl
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6
Q

What is the name given to analgesics used in these 3 stages?

A
  • Broad spectrum analgesia
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7
Q

What is the difference between baseline pain and breakthrough pain?

A

Baseline pain = underlying pain
Breakthrough pain = peaks

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8
Q

How do you manage baseline pain and breakthrough pain?

A

If a patient was receiving morphine

Baseline pain
* Regular medications to maintain baseline pain e.g. modified release morphine

Breakthrough pain
* Immediate release morphine

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9
Q

What is one of the challenges of moving from one type of analgesic to another type of analgesic?

A

How do you convert a patient on drug x to drug y?

How do you convert a patient on formulation drug x to another formulation drug x

It can also be the case when using morphine for example, changing the route of administration is not a like for like conversion

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10
Q

How do you treat malignant bone pain?

A
  • Radiotherapy
    • Broad spectrum analgesia
    • Opioids
    • Bisphosphonates
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11
Q

Why are Bisphosphonates used in the management of bone cancer pain?

A
  • Bone cancer needs space in the bone matrix to grow
  • Bisphosphonates reduce this space
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12
Q

How would a patient describe neuropathic pain?

A
  • Electric shock like
  • Stabbing pain
  • Pins and needles
  • Throbbing
  • Burning
  • Numb
  • Shooting pains
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13
Q

How would you manage neuropathic pain?

A

Paracetamol, NSAID and opioids have limited effect vs neuropathic pain

Amitriptyline 1st line

Garbapentin, fewer side effects, but has to be tolerated up to get the effective dose, which take a couple of weeks.

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14
Q

What are the causes of constipation?

A
  • Physical activity
  • Lack of privacy in healthcare environment
  • Drugs
  • Boewl metastasis
  • Electrolyte imbalance e.g. hypercalcaemia
  • Underlying disease e.g. Parkinsons Disease, Stroke, MS
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15
Q

Non pharmacological mgmt of constipation

A
  • Regular physical exercise
  • Avoid ignoring the need to go
  • Ensure the patient eats at least 30g of fibre and 2 litres of water per day.
  • Good toilet position
  • Avoid constipating medications
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16
Q

What is a 1st line therapeutic option?

A

Stool softners – Docusate
* Pulls water and fat into stool

17
Q

What is a complications of constipation?

A

Faecal impaction

18
Q

When should it be suspected

A
  • Hard lumpy stools
    • Over flow diarrhoea
    • Using manual methods to extract faeces
19
Q

How is faecal impaction treated?

A
20
Q

How might a patient receiving chemo feel sick

A

Vomiting centre is influenced by:

* Higher coirtical centres – memory
* Chemotherapy trigger centres
* Labyrinths
21
Q

What effects the chemotherapy trigger centre?

A

Chemotherapy effects the chemotherapy trigger cetre and this has a knock on effect to the vomiting centre in the brain

22
Q

How do labyrinths influence nausea and vomiting?

A

Effected by balance
Travel sickness
Sea sickness
Virtigo
Surgery

23
Q

What is the Tx approach for a patient receiving a CT with a** low risk** of N&V before CT starts

A

Dopamine 2 andrenergic receptor antagonist

Metoclopromide

24
Q

**What is the Tx approach for a patient receiving CT with a **low risk **of N&V after CT starts

A

Dopamine 2 andrenergic receptor antagonist

Metoclopromide

25
Q

What is the Tx approach for a patient receiving a CT with a Medium risk of N&V before CT starts

A
  • Corticosteriod - Dexamethasone
  • Proton pump inhibitor - Lansoprasole
  • 5 Hydroxytryptamine inhibitor - Ondansetron
26
Q

What is the Tx approach for a patient receiving a CT with a Medium risk of N&V after CT starts

A
  • Corticosteriod - Dexamethasone
  • Proton pump inhibitor - Lansoprasole
  • 5 Hydroxytryptamine inhibitor - Ondansetron
27
Q

What is the Tx approach for a patient receiving a CT with a High risk of N&V before CT starts

A
  • Corticosteriod - Dexamethasone
  • Proton pump inhibitor - Lansoprasole
  • 5 Hydroxytryptamine inhibitor - Ondansetron
28
Q

What is the Tx approach for a patient receiving a CT with a High risk of N&V after CT starts

A
  • Corticosteriod - Dexamethasone
  • Proton pump inhibitor - Lansoprasole
  • 5 Hydroxytryptamine inhibitor - Ondansetron
  • Neurokinin 1 inhibitor - Aprepitat
29
Q

Which other type of medication might be used for N&V associatd with other causes?

A
  • Cyclizine - An antihistamine
30
Q

What is the 1st line treatment for nausea and vomiting in parkinsons disease?

A

A dopamine 2 antagonist
Domperidone

Cannot use the other drugs which work in the brain as it makes PD worse

31
Q

What are 4 respiratory conditions which may require palliative care?

A
  1. Secretions
    1. Shortness of breath
    2. Anxiety
    3. Cough
32
Q

How are these 4 respiratory complications treated?

A
33
Q

What other complications may be seen in palliative care?

A
  • Hiccups
  • Diarrhoea
  • Itching
  • Mouth problems
34
Q

How might these side effects be treated?

A

Cancer (37 decks)

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