Cancer Supportive Care Flashcards
What are examples of bulk forming laxatives?
Fybogel and metamucil
What are some precautions for bulk forming laxatives?
- must drink extra fluids
- not usually used in palliative care
- NOT SUITABLE in bowel obstruction
What are some examples of stimulant laxatives?
senna and bisacodyl
What are some precautions for stimulant laxatives?
Unsuitable for complete bowel obstruction
What are examples of osmotic laxatives?
Lactulose, Forlax and phosphate enemas
What precaution must be taken for osmotic laxatives?
must drink extra fluids
What are some advice for constipation?
- preventive treatment should be introduced before clinical problems develop
- pt should be compliant to regular laxatives as long as on opioids
- encourage fluid intake, especially fruit juice and fruits
How do we manage intestinal obstruction?
- reverse obstruction if possible
- provide symptom relief
- gut rest
- nil by mouth
- IV hydration (pt usually v dry)
For cancer patients, IO is usually non-operable. What should we do next?
- See if stenting is needed:
- CI to stenting: pt with multiple levels of obstruction, and pts w rectal tumours due to stent migration
- If stenting cannot be done, consider trial of steroids to reduce edema and inflammation - Complete IO (completely blocked):
- pain relief with opioids (morphine) plus minus anticholinergic agents
- if patients have N&V, use SC haloperidol. if high volume vomiting, possible to use NGT to draw out vomitus or octreotide.
- prokinetics contraindicated due to risk of perforation - Incomplete IO:
- pain relief with fentanyl
- consider buscopan only if pain is not relieved
- treat N&V with metoclopramide
- continue to clear bowels w for eg fleet/lactulose
What dietary advice should be given to IO patients?
- low residue/low fibre diet
- limit fat intake
What are the medications that can be used for diarrhoea? Contraindications?
- codeine phosphate (using its SE of constipation to treat diarrhoea, helpful when some pain relief is needed as well) -> avoid concurrent sedatives, narcotics or alcohol
- diphenoxylate/atropine (lomotil) -> CI in age <12, liver disease and infectious diarrhoea
- loperamide (imodium) -> CI in age<12 and infectious diarrhoea
- octreotide (only used when there is a lot of secretory effect from the tumour at the gut; SC injection; can cause glucose imbalance) -> CI in infectious diarrhoea
What dietary advice can we give for diarrhoea?
- eat small frequent meals
- eat low fibre food
- maintain good fluid intake
- avoid high fibre food, coffee, tea, milk, alcohol, sweets, fried, greasy or highly spiced food
- gradually reintroduce proteins and then fats to the diet as diarrhoea resolves
How is oxygen used for managing dyspnoea?
- trial of oxygen for hypoxic patients (SpO2 < 90%)
How are opioids used in managing dyspnoea?
Useful for SOB at rest/minimal exertion and in the terminal phase in cancer/non-cancer patients.
eg. morphine can be given -> suppresses respiratory centre
What other strategies can be used to manage dyspnoea?
- steroids eg dexamethasone to reduce peritumoural edema
- anxiolytics eg lorazepam and midazolam to allay anxiety
- treatment of secretions: nebulized sodium chloride to loosen secretions, and anticholinergics like buscopan to decrease and loosen secretions. Suctioning not recommended.
