Chapter 2 - specific conditions Flashcards
How common is cancer?
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
where does stomach cancer most commonly spread to?
liver
where does breast, lung and prostate most commonly metastasise to?
bone
where does breast and kidney cancer metastasise to?
lung
where does lung, gut and breast commonly spread to?
brain
what are the 4 different types of MND?
Amyotrophic lateral sclerosis (ALS)
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis (very rare)
what are the most common symptoms of ALS?
tripping
dropping things
progressive weakness and wasting in limbs
muscle cramps and stiffness
what are the most common symptoms of progressive bulbar palsy?
mainly affects muscles of face, throat and tongue
slurring of speech
difficulty swallowing
what is the prognosis of ALS?
two to five years from onset of symptoms
what is the prognosis of progressive bulbar palsy?
six months to three years from onset of symptoms
what are the most common symptoms of progressive muscular atrophy?
weakness or clumsiness of the hands
prognosis of progressive muscular atrophy?
usually more than 5 years
what are the most common symptoms of primary lateral sclerosis?
mainly weakness in the lower limbs
some people will have clumsiness in hands and speech problems
what is the prognosis of primary lateral sclerosis?
10-20 years
what are the some of the common general symptoms of MND?
insomnia - due to pain, depression or fear (i.e of choking) stiff joints dypshagia/nutritional needs dysarthria + communication needs drooling (sialorrhea)
what can help with stiff joints experienced by patients with MND?
active/assisted and passive excersises, massage, and appropriate positioning
NSAIDS
what can help with muscle spasm experienced by patients with MND?
baclofen and diazepam
what can help with muscle cramps experienced by patients with MND?
quinine sulphate
what can help with dysphagia/swallowing difficulties experienced by patients with MND?
SLT referral
small, frequent meals
solid food that is moist and soft
artificial feeding if appropriate
what can help with dysarthria experienced by patients with MND?
light writers with synthesized voice function, ipads and tablet devices
alphabet boards, yes/no boards, picture boards
what can help with sialorrhoea experienced by patients with MND?
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
in which situation is suction used in EOL care?
MND to improve ventilation and oxygenation
what usually causes breathlessness in MND?
diaphragmatic and respiratory muscle weakness
symptoms of nocturnal hypoventilation?
tiredness nightmares early morning headaches day time tiredness impaired concentration
management of nocturnal hypoventilation?
nocturnal NIV
what are the common fears/concerns of patients with MND?
a fear of manner of death - many fear choking to death loss of autonomy
what are the 4 types of MS?
relapsing remitting
secondary progressive
primary progressive
progressive relapsing
pathophysiology of MS?
autoimmune disease leading to the demyelination of myelin sheath leading to scarring of axons in brain and spinal cord
what age is MS most common?
20-30 years of age
which gender is MS most common?
women
symptoms of MS?
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
what types of pain do patients with MS suffer from and what can be prescribed to help?
neuropathic pain - usually lower limbs, consider pregabalin, gabapentin, or amitriptyline
MSK pain - particularly back pain, consider NSAIDS or paracetamol
what are non-pharmacological measures to help with pain in MS?
early physiotherapy involvement wheelchair adaptations mobility aids TENS machine acupuncture massage
what is l’hermittes?
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
management of trigeminal neuralgia?
carbamazepine
gabapentin
management of tremors/ataxia?
early OT involvement
pelvic and thoracic support
what are some of the bladder symptoms patients with MS can experience?
hyperreflexia of the bladder - low volume capacity bladder and symptoms of urgency, frequency and incontinence
incomplete bladder emptying
nocturnal incontinence
bladder spasm
what are some of the treatments that can be offered for the bladder symptoms experienced by patients with MS?
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
what causes constipation in MS?
poor fluid intake
delayed gut transit time
immobility
anticholinergic medication
first line management of muscle spasticity in MS?
baclofen 5mg TDS up to 100mg
gabapentin 300mg note then increase by 300mg every 2-3 days until symptomatic improvement
how should baclofen be reduced in dose?
gradually - sudden reduction may cause hallucinations
what is the second line management of spasticity in patients with MS?
dantrolene sodium 25mg (starting dose)
Tizanadine 2mg
what is the third line medication for muscle spasticity in MS?
benzodiazepines e.g. diazepam
what can cause increased fatigue in patients with MS?
hot baths
hot weather
how many people currently live with dementia in the uk?
850,000, it is estimated to increase to 1 million by 2025 and 2 million in 2051
what factors can affect prognosis in dementia?
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)
what are the different types of dementia?
alzhiemers
vascular dementia
dementia with lewy bodies
frontotemporal dementia
symptoms of Alzheimer’s?
lapses in memory problems finding correct words frequently forgetting names mood swings increasing withdrawal difficulty carrying out normal day to day activities
symptoms of vascular dementia?
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
symptoms of Lewy body dementia?
hallucinations muscle stiffness slower movement sharing and trembling of arms and legs shuffling while walking sleep problems loss of facial expression aka parkinsons
what is frontotemporal dementia?
picks disease - shrinking of the frontal and temporal anterior lobes of the brain
condition is familial and usually affects younger people
symptoms of frontotemporal dementia?
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
what are the aims of pharmacological management of dementia?
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
what are the two many drug groups used to treat dementia?
acetylcholinesterase inhibitors
N-methy-d-aspartate receptor antagonists
how do acetylcholinesterase inhibitors work?
acetylcholinesterase inhibitors act by preventing the breakdown of the neurotransmitter associated with memory (acetylcholine)
what are some examples of acetylcholinesterase inhibitors?
donepazil
rivastigmine
galantamine
what are some behavioural and psychological symptoms of dementia?
delusions vivid hallucinations illusion anxiety disinhibited behaviour agitation apathy and depression aggression elation
what is the pharmacological management of behavioural and psychological symptoms of dementia?
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
when should antipsychotic medications never be used?
in Lewy body DEMENTIA - CATASTROPHIC REACTIONS
What are some signs in patients with dementia that they are in pain (if they are unable to verbalise)?
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
how can you facilitate helping a person with dementia to eat?
good mouthcare
soft foods
foods easy to hold in your hand
cues such as setting a dining table
what are some methods to be considered when looking after someone who has dementia?
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
how should acetylcholinesterase inhibitors be stopped?
gradually reduce as stopping abruptly may cause acute deterioration in symptoms
how can you classify heart failure?
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
what are some SE of NSAIDS in patients with HF?
salt and water retention
what are some SE of TCA in patients with heart failure?
anticholinergic effects on the heart
what are some SE of cyclizine on patients with HF?
anticholinergic effects on the heart
what are some SE of steroids in patients with HF?
water retention
what are some non-pharmacological interventions for breathlessness?
hand held fan relaxation breathing techniques exercise stress reduction programme
warning signs that a patient with HF is approaching EOL?
repeated hospital admissions
worsening electrolyte imbalance
fluid weight gain with muscle weight loss
decreasing functional status
what egfr is end stage renal failure?
<15
clinical features of renal failure?
pain fatigue and weakness pruritis anorexia sleep disturbances anxiety and depression nausea restless legs dyspnoea
how does renal failure cause an increase in drug side effects?
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
what can happen to a patients analgesia who is having dialysis?
haemodyalsis can clear the analgesia leaving the patient in pain
how do you treat uraemia in end stage renal failure?
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
what are the three aspects of a learning disability?
1) impaired intelligence
2) reduced ability to cope independently
3) start in childhood, with lasting effect on development
