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Cancer kanser wtv > everySupportivething > Flashcards

everySupportivething Flashcards

1
Q

Symptoms of Constipation

A

Unable move bowels, push harder to move bowels, moving them less often than usual

Faeces small, dry and hard

Significant variation from normal bowel habit

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2
Q

Causes of constipation

A

Biochemical (Hypercalcemia, Hypokalaemia)
Fluid depletion
Medication (Opioids)
Weakness
Disease related (Immobility, tumour invasion)

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3
Q

Complications of constipation

A 
Colic/ abdominal discomfort
Overflow diarrhoea
Restlessness/ confusion if severe
Intestinal obstruction
Faecal incontinence
Urinary retention
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4
Q

What are the bulk forming laxatives? State dose

A

Fybogel, Metamucil

1 satchel BD

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5
Q

What are the osmotic laxatives? State dose

A

Phosphate enemas
Forlax,
Lactulose - 10-15ml BD
PEG

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6
Q

What are the stimulant laxatives? State dose

A

Senna - 2-4 tabs daily

Bisacodyl - 5-10 mg ON, up to 20mg daily

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7
Q

If rectum is impacted and stools are hard? WYD?

A

Lubricate with glycerin suppositories OR soften with olive oil enema followed by phosphate enema once softened

Once disimpacted, commence or increase oral stimulant/ softener

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8
Q

If rectum is impacted and stools are soft? WYD?

A

Use a rectal stimulant

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9
Q

If rectum not impacted and not dilated? WYD?

A

Consider additional laxatives, ensure pt is on regular laxatives.

Exclude intestinal obstruction

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10
Q

If rectum not impacted BUT dilated, WYD?

A

Suggest constipation is higher up, give high feet enema (phosphate enema) over several days

If colic present –> Reduce stimulant laxative, add softener or osmotic agent

If colic not present –> Add or increase stimulant laxative +/- softener

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11
Q

Symptoms of IO

A

Vomiting, abdominal distention, abdominal pain, constipation, anorexia

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12
Q

Treatment of Complete I/O?

A

Pain relief with opioid (Morphine) +/- anticholinergic (Buscopan/ Hyoscine)

If N/V present, give Haloperidol, consider nasogastric tube feeding OR octreotide if high volume vomiting

Prokinetics contraindicated

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13
Q

Treatment of incomplete I/O?

A

Pain relief with Fentanyl, consider adding Buscopan if pain not relieved

If N/V present, give Metoclopramide

Continue to clear bowel with high fleet/ lactulose

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14
Q

I/O counselling points?

A 
Take a low residue/ low fibre meal
Avoid food made with seeds, nuts or raw/dried fruit
Avoid whole grain breads and cereal
Avoid raw fruits/ vegetables
Avoid tough fibrous meat
Limit fat intake
Remove skin before cooking
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15
Q

Symptoms of diarrhoea

A

More than 3 unformed stool in 24 hrs

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16
Q

Causes of diarrhoea?

A

Diet related (spicy food/ alcohol, fruits),
treatment related, (Chemo, radio)
medication, (Laxatives, NSAIDs, Chemo, Abx)
overflow diarrhoea

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17
Q

Drugs for management of Laosai?

A

Codeine Phosphate
Diphenoxylate/ Atropine
Loperamide HCl
Octreotide

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18
Q

Doses for drugs used in Laosai?

A

Codeine - 30-60mg Q4-6h PRN

Diphenoxylate/ Atropine - 1-2 tabs, 3-4 times daily, MAX: 8 tabs

Loperamide HCL - 4-16mg daily.

Octreotide - 50-200mcg SC, 2-3 times daily

19
Q

Contraindication of laosai drugs?

A

Codeine - Caution in pt with COPD/Asthma, hepatic/renal dysfunction

Diphenoxylate/Atropine - Age <12, Infectious laosai, liver disease

Loperamide - Age <12, Infectious Laosai

Octreotide - Infectious laosai

20
Q

Counselling points for laosai?

A

Eat small frequent meals

Eat low fibre meals

Maintain good fluid intake

Avoid high fibre food, greasy/oily food, spicy food

Avoid coffee, tea, milk, milk products, alcohol and sweets

Gradually introduce proteins then fat into diet

21
Q

Causes of Dysponea?

A

Respiratory - Pleural effusion, PE/COPD exacerbation, Lymphangitis, Pneumonia, Collapse/Consolidation from Tumour

Cardiovascular - Pericardial effusion, Congestive Cardiac Failure

Abdominal - Liver failure leading to fluid overload, ascites causing diaphragmatic splinting

Systemic - Anemia

22
Q

List the class of meds used for treatment of dysponea

A

Oxygen, Opioids, Anxiolytic, Steroids, Treatment of secretion

23
Q

List the Anxiolytics used in Dysponea

A

S/L Lorazepam, IV/SC Midozalam (if terminal, unable to tolerate oral)

Escitalopram (if longer prognosis and has panic attack)

24
Q

List the steroid used in dysponea

A

Dexamethasone

25
Q

List the agents used in treatment of secretion in dysponea

A

Nebulised NaCL 0.9%

Buscopan

26
Q

List the opioid used in dysponea

A

Morphine, Fentanyl (if pt has renal impairments)

27
Q

Can oxygen be used on non-hypoxic patients for dysponea

A

No, only hypoxic pts

28
Q

Counselling points of dyspnoea

A

Learn breathing techniques, anxiety management techniques

Break tasks into smaller bits, plan and pace activities, use aids if necessary

Learn to find comfortable positions

Open windows, use electric fans to increase sensation of moving air (Non-hypoxic pts only)

Consider using breakthrough opioids prior to major movement and activities

Consider joining support groups/ rehab groups

29
Q

List the causes of N/V and the appropriate drug class to treat them

A

Clinical toxicity - Dopamine receptor antagonists

Motility disorder - Prokinetics

Intracranial disorders - Antihistamines, Anticholinergics

Oral/pharyngeal/oesophageal irritation - Antihistamines, Anticholinergics

Higher centres (Pain/fear/anxiety) - Optimise pain control, treat anxiety

Multifactorial/ unknown - Appropriate anti-emetics

Chemo - Refer local guidelines (LOL)

30
Q

List the anti-emetic drugs used

A

Domperidone, Haloperidol, Metoclopramide, Ondansetron, Buclizine, Mirtazapine, Olanzapine

31
Q

Screening tool for depression?

A

PHQ-9

32
Q

Monoamines involved in depression?

A

Noradrenaline, Serotonin, Dopamine

33
Q

Goal of pharmacologic treatment in depression?

A

Resolution of current symptoms, prevention of recurrences

34
Q

Benefits of SSRI and Mirtazapine?

A

SSRI are better tolerated, Mirtazapine is well tolerated in patient with heart failure and the elderly

35
Q

Causes of Xerostomia

A

Radiotherapy to neck and head region

Surgery involving removal of salivary gland

Certain chemo agents

Oral infections

36
Q

Medication used for xerostomia?

A

Pilocarpine 5-10ml TDS

37
Q

List and describe the three types of delirium

A

Hyperactive - Increased arousal and agitation
Hypoactive - Quiet and withdrawn
Mixed

38
Q

Causes of delirium?

A

Drugs - especially opioid toxicity, corticosteroids can cause florid delirium

Drug withdrawal

Dehydration, constipation, urinary retention

Uncontrolled pain

Liver or renal impairment

Electrolyte disturbances (Na/glucose), hypercalcaemia

alot more, i lz type

39
Q

Risk factors for delirium

A

Visual and auditory impairment

40
Q

Screening tools for delirium?

A

Mini-mental state examination (MMSE)

Confusion assessment method (CAM)

41
Q

Drugs used for delirium?

A

Haloperidol - 1st choice

Benzodiazepines - 2nd choice
Lorazepam
Midazolam
Diazepam

42
Q

Topical agents for pruritis?

A 
Emollients/ Emollients with antipruritic agents
Crotamiton 10% cream
Capsaicin (0.025%) cream
Topical corticosteroid
Lidocaine patches
43
Q

6 causes of pruritis?

A

Cholestasis, Uraemia, Paraneoplastic, Lymphoma, Systemic opioid induced pruritis

44
Q

Drugs used to treat the 6 causes of pruritis?

A

Cholestasis - Rifampicin, Sertraline, Cholestyramine
Uraemia - Gabapentin, Naltrexone, Mirtazapine
Lymphoma - Prednisolone, Cimetidine, Mirtazapine
Systemic opioid-induced - Chlorphenamine, Ondasetron
Paraneoplastic - Paroxetine, Mirtazapine
Unknown- Chlorphenamine, Paroxetine, Mirtazapine

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