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Palliative Care > Chapter 2 - specific conditions > Flashcards

Chapter 2 - specific conditions Flashcards

1
Q

How common is cancer?

A

1 in 3 people will develop cancer
1 in 4 will die from the disease
4 out of the 10 leading causes of death are from cancer

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2
Q

where does stomach cancer most commonly spread to?

A

liver

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3
Q

where does breast, lung and prostate most commonly metastasise to?

A

bone

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4
Q

where does breast and kidney cancer metastasise to?

A

lung

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5
Q

where does lung, gut and breast commonly spread to?

A

brain

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6
Q

what are the 4 different types of MND?

A

Amyotrophic lateral sclerosis (ALS)
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis (very rare)

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7
Q

what are the most common symptoms of ALS?

A

tripping
dropping things
progressive weakness and wasting in limbs
muscle cramps and stiffness

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8
Q

what are the most common symptoms of progressive bulbar palsy?

A

mainly affects muscles of face, throat and tongue
slurring of speech
difficulty swallowing

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9
Q

what is the prognosis of ALS?

A

two to five years from onset of symptoms

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10
Q

what is the prognosis of progressive bulbar palsy?

A

six months to three years from onset of symptoms

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11
Q

what are the most common symptoms of progressive muscular atrophy?

A

weakness or clumsiness of the hands

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12
Q

prognosis of progressive muscular atrophy?

A

usually more than 5 years

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13
Q

what are the most common symptoms of primary lateral sclerosis?

A

mainly weakness in the lower limbs

some people will have clumsiness in hands and speech problems

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14
Q

what is the prognosis of primary lateral sclerosis?

A

10-20 years

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15
Q

what are the some of the common general symptoms of MND?

A 
insomnia - due to pain, depression or fear (i.e of choking)
stiff joints 
dypshagia/nutritional needs 
dysarthria + communication needs
drooling (sialorrhea)
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16
Q

what can help with stiff joints experienced by patients with MND?

A

active/assisted and passive excersises, massage, and appropriate positioning
NSAIDS

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17
Q

what can help with muscle spasm experienced by patients with MND?

A

baclofen and diazepam

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18
Q

what can help with muscle cramps experienced by patients with MND?

A

quinine sulphate

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19
Q

what can help with dysphagia/swallowing difficulties experienced by patients with MND?

A

SLT referral
small, frequent meals
solid food that is moist and soft
artificial feeding if appropriate

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20
Q

what can help with dysarthria experienced by patients with MND?

A

light writers with synthesized voice function, ipads and tablet devices
alphabet boards, yes/no boards, picture boards

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21
Q

what can help with sialorrhoea experienced by patients with MND?

A

anticholinergic - hyoscine hydrobromide patch (can cause confusion and sedation)
glycopyrronium - recommended for patients with cognitive dysfunction as this has less central side effects
botulinum toxin A (if the above are not effective)
comfort measures - regular mouth care, positioning, advice on swallowing

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22
Q

in which situation is suction used in EOL care?

A

MND to improve ventilation and oxygenation

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23
Q

what usually causes breathlessness in MND?

A

diaphragmatic and respiratory muscle weakness

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24
Q

symptoms of nocturnal hypoventilation?

A 
tiredness
nightmares
early morning headaches
day time tiredness 
impaired concentration
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25
Q

management of nocturnal hypoventilation?

A

nocturnal NIV

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26
Q

what are the common fears/concerns of patients with MND?

A

a fear of manner of death - many fear choking to death loss of autonomy

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27
Q

what are the 4 types of MS?

A

relapsing remitting
secondary progressive
primary progressive
progressive relapsing

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28
Q

pathophysiology of MS?

A

autoimmune disease leading to the demyelination of myelin sheath leading to scarring of axons in brain and spinal cord

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29
Q

what age is MS most common?

A

20-30 years of age

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30
Q

which gender is MS most common?

A

women

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31
Q

symptoms of MS?

A

changes in vision - loss or reduction, painful eye movements, optic neuritis
ascending motor and/or sensory dysfunction in limbs or face
loss of balance, vertigo, excessive clumsiness, gait changes
pain and spasticity
fatigue
tingling, numbness
sexual dysfunction
loss of continence
l’hermittes
common triad charcots: dysarthria, nystagmus, intention tremor

32
Q

what types of pain do patients with MS suffer from and what can be prescribed to help?

A

neuropathic pain - usually lower limbs, consider pregabalin, gabapentin, or amitriptyline
MSK pain - particularly back pain, consider NSAIDS or paracetamol

33
Q

what are non-pharmacological measures to help with pain in MS?

A 
early physiotherapy involvement 
wheelchair adaptations 
mobility aids 
TENS machine 
acupuncture 
massage
34
Q

what is l’hermittes?

A

intermittent burning sensations or electric shock in the neck
likely due to demyelination in the posterior column of the spinal cord
often self limiting - however cervical collar may be helpful

35
Q

management of trigeminal neuralgia?

A

carbamazepine

gabapentin

36
Q

management of tremors/ataxia?

A

early OT involvement

pelvic and thoracic support

37
Q

what are some of the bladder symptoms patients with MS can experience?

A

hyperreflexia of the bladder - low volume capacity bladder and symptoms of urgency, frequency and incontinence
incomplete bladder emptying
nocturnal incontinence
bladder spasm

38
Q

what are some of the treatments that can be offered for the bladder symptoms experienced by patients with MS?

A

hyperreflexia of bladder- treated by anticholinergic drugs such as oxybutynin or tolterodine
incomplete bladder emptying - self catheterization
nocturnal incontinence - 10 - 20 micrograms nasal spray desmopressin

39
Q

what causes constipation in MS?

A

poor fluid intake
delayed gut transit time
immobility
anticholinergic medication

40
Q

first line management of muscle spasticity in MS?

A

baclofen 5mg TDS up to 100mg

gabapentin 300mg note then increase by 300mg every 2-3 days until symptomatic improvement

41
Q

how should baclofen be reduced in dose?

A

gradually - sudden reduction may cause hallucinations

42
Q

what is the second line management of spasticity in patients with MS?

A

dantrolene sodium 25mg (starting dose)

Tizanadine 2mg

43
Q

what is the third line medication for muscle spasticity in MS?

A

benzodiazepines e.g. diazepam

44
Q

what can cause increased fatigue in patients with MS?

A

hot baths

hot weather

45
Q

how many people currently live with dementia in the uk?

A

850,000, it is estimated to increase to 1 million by 2025 and 2 million in 2051

46
Q

what factors can affect prognosis in dementia?

A 
type of dementia - vascular dementia carries a much poorer prognosis of less than 5 years
general health at diagnosis
functional ability (stronger indicator than cognitive ability)
47
Q

what are the different types of dementia?

A

alzhiemers
vascular dementia
dementia with lewy bodies
frontotemporal dementia

48
Q

symptoms of Alzheimer’s?

A 
lapses in memory
problems finding correct words
frequently forgetting names 
mood swings
increasing withdrawal
difficulty carrying out normal day to day activities
49
Q

symptoms of vascular dementia?

A 
slowness of thought, problems with planning or organising, making decisions or solving problems
difficulty planning and understanding
problems with conc
mood swings
feeling disoriented or confused
difficulty walking or with balance
50
Q

symptoms of Lewy body dementia?

A 
hallucinations
muscle stiffness
slower movement
sharing and trembling of arms and legs
shuffling while walking
sleep problems
loss of facial expression 
aka parkinsons
51
Q

what is frontotemporal dementia?

A

picks disease - shrinking of the frontal and temporal anterior lobes of the brain
condition is familial and usually affects younger people

52
Q

symptoms of frontotemporal dementia?

A 
behavioural changes happen first 
poor judgement 
loss of empathy
socially inappropriate behaviour 
lack of inhibition 
repetitive compulsive behaviour 
inability to concentrate on plan 
frequent, abrupt mood changes
speech difficulties
problems with balance or movement
53
Q

what are the aims of pharmacological management of dementia?

A

reduce rate of cognitive decline
improve existing symptoms and functioning
delay onset of behavioural and psychological symptoms
help the person with dementia to stay at home for as long as possible

54
Q

what are the two many drug groups used to treat dementia?

A

acetylcholinesterase inhibitors

N-methy-d-aspartate receptor antagonists

55
Q

how do acetylcholinesterase inhibitors work?

A

acetylcholinesterase inhibitors act by preventing the breakdown of the neurotransmitter associated with memory (acetylcholine)

56
Q

what are some examples of acetylcholinesterase inhibitors?

A

donepazil
rivastigmine
galantamine

57
Q

what are some behavioural and psychological symptoms of dementia?

A 
delusions
vivid hallucinations
illusion anxiety
disinhibited behaviour
agitation
apathy and depression 
aggression
elation
58
Q

what is the pharmacological management of behavioural and psychological symptoms of dementia?

A

acetylcholinesterase inhibitors
antidepressants
antipsychotics - should only be used when all other treatments have failed due to their negative impact on mortality potentially through increase falls, infections and extrapyramidal SE

59
Q

when should antipsychotic medications never be used?

A

in Lewy body DEMENTIA - CATASTROPHIC REACTIONS

60
Q

What are some signs in patients with dementia that they are in pain (if they are unable to verbalise)?

A

vocalisation - groaning, crying, calling out
facial expression - frowning, grimacing
body language - rocking, guarding, massaging/patting of painful area, refusing to eat, inability to stay still
physiological indicators - BP, flushing, perspiring, pulse changes

61
Q

how can you facilitate helping a person with dementia to eat?

A

good mouthcare
soft foods
foods easy to hold in your hand
cues such as setting a dining table

62
Q

what are some methods to be considered when looking after someone who has dementia?

A

colour - ensure staff wear bright colours, where appropriate paint doors etc.
sign posting- clearly label doors/rooms
reminisence- photos and books, objects associated with their past
music therapy - old music they like
sleep - reducing caffeine, active days, maintaining routine, creating calm/quiet atmosphere

63
Q

how should acetylcholinesterase inhibitors be stopped?

A

gradually reduce as stopping abruptly may cause acute deterioration in symptoms

64
Q

how can you classify heart failure?

A

New York Heart Association functional classifications:
I - heart disease present but no undue dyspnoea
II - comfortable at rest, dyspnoea on ordinary activities
III - less than ordinary activity cause dyspnoea which is limiting
IV - dyspnoea present at rest, all activities cause discomfort

65
Q

what are some SE of NSAIDS in patients with HF?

A

salt and water retention

66
Q

what are some SE of TCA in patients with heart failure?

A

anticholinergic effects on the heart

67
Q

what are some SE of cyclizine on patients with HF?

A

anticholinergic effects on the heart

68
Q

what are some SE of steroids in patients with HF?

A

water retention

69
Q

what are some non-pharmacological interventions for breathlessness?

A 
hand held fan
relaxation
breathing techniques
exercise
stress reduction programme
70
Q

warning signs that a patient with HF is approaching EOL?

A

repeated hospital admissions
worsening electrolyte imbalance
fluid weight gain with muscle weight loss
decreasing functional status

71
Q

what egfr is end stage renal failure?

A

<15

72
Q

clinical features of renal failure?

A 
pain
fatigue and weakness
pruritis
anorexia
sleep disturbances
anxiety and depression 
nausea
restless legs
dyspnoea
73
Q

how does renal failure cause an increase in drug side effects?

A

decreasing plasma protein binding capacity due to the loss of protein and altered binding ability caused by uraemia
decreased excretion so increased build up of metabolites
changes in hydration affects the distribution of the drug in the body
reduction in oral absorption of the drug due to vomiting, and diarrhoea
increasing permeability of the blood brain barrier in uraemia which may cause CNS side effects

74
Q

what can happen to a patients analgesia who is having dialysis?

A

haemodyalsis can clear the analgesia leaving the patient in pain

75
Q

how do you treat uraemia in end stage renal failure?

A

good skin care with regular use of emollients +/- antihistamine
aluminium hydroxide as a phosphate binder to reduce uraemia
regular antiemetics - uraemia can cause vomiting and nausea

76
Q

what are the three aspects of a learning disability?

A

1) impaired intelligence
2) reduced ability to cope independently
3) start in childhood, with lasting effect on development

Palliative Care (10 decks)

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