everySupportivething Flashcards
Symptoms of Constipation
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
Causes of constipation
Biochemical (Hypercalcemia, Hypokalaemia)
Fluid depletion
Medication (Opioids)
Weakness
Disease related (Immobility, tumour invasion)
Complications of constipation
Colic/ abdominal discomfort Overflow diarrhoea Restlessness/ confusion if severe Intestinal obstruction Faecal incontinence Urinary retention
What are the bulk forming laxatives? State dose
Fybogel, Metamucil
1 satchel BD
What are the osmotic laxatives? State dose
Phosphate enemas
Forlax,
Lactulose - 10-15ml BD
PEG
What are the stimulant laxatives? State dose
Senna - 2-4 tabs daily
Bisacodyl - 5-10 mg ON, up to 20mg daily
If rectum is impacted and stools are hard? WYD?
Lubricate with glycerin suppositories OR soften with olive oil enema followed by phosphate enema once softened
Once disimpacted, commence or increase oral stimulant/ softener
If rectum is impacted and stools are soft? WYD?
Use a rectal stimulant
If rectum not impacted and not dilated? WYD?
Consider additional laxatives, ensure pt is on regular laxatives.
Exclude intestinal obstruction
If rectum not impacted BUT dilated, WYD?
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
Symptoms of IO
Vomiting, abdominal distention, abdominal pain, constipation, anorexia
Treatment of Complete I/O?
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
Treatment of incomplete I/O?
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
I/O counselling points?
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
Symptoms of diarrhoea
More than 3 unformed stool in 24 hrs
Causes of diarrhoea?
Diet related (spicy food/ alcohol, fruits),
treatment related, (Chemo, radio)
medication, (Laxatives, NSAIDs, Chemo, Abx)
overflow diarrhoea
Drugs for management of Laosai?
Codeine Phosphate
Diphenoxylate/ Atropine
Loperamide HCl
Octreotide
Doses for drugs used in Laosai?
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
Contraindication of laosai drugs?
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
Counselling points for laosai?
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
Causes of Dysponea?
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
List the class of meds used for treatment of dysponea
Oxygen, Opioids, Anxiolytic, Steroids, Treatment of secretion
List the Anxiolytics used in Dysponea
S/L Lorazepam, IV/SC Midozalam (if terminal, unable to tolerate oral)
Escitalopram (if longer prognosis and has panic attack)
List the steroid used in dysponea
Dexamethasone
List the agents used in treatment of secretion in dysponea
Nebulised NaCL 0.9%
Buscopan
List the opioid used in dysponea
Morphine, Fentanyl (if pt has renal impairments)
Can oxygen be used on non-hypoxic patients for dysponea
No, only hypoxic pts
Counselling points of dyspnoea
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
List the causes of N/V and the appropriate drug class to treat them
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)
List the anti-emetic drugs used
Domperidone, Haloperidol, Metoclopramide, Ondansetron, Buclizine, Mirtazapine, Olanzapine
Screening tool for depression?
PHQ-9
Monoamines involved in depression?
Noradrenaline, Serotonin, Dopamine
Goal of pharmacologic treatment in depression?
Resolution of current symptoms, prevention of recurrences
Benefits of SSRI and Mirtazapine?
SSRI are better tolerated, Mirtazapine is well tolerated in patient with heart failure and the elderly
Causes of Xerostomia
Radiotherapy to neck and head region
Surgery involving removal of salivary gland
Certain chemo agents
Oral infections
Medication used for xerostomia?
Pilocarpine 5-10ml TDS
List and describe the three types of delirium
Hyperactive - Increased arousal and agitation
Hypoactive - Quiet and withdrawn
Mixed
Causes of delirium?
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
Risk factors for delirium
Visual and auditory impairment
Screening tools for delirium?
Mini-mental state examination (MMSE)
Confusion assessment method (CAM)
Drugs used for delirium?
Haloperidol - 1st choice
Benzodiazepines - 2nd choice
Lorazepam
Midazolam
Diazepam
Topical agents for pruritis?
Emollients/ Emollients with antipruritic agents Crotamiton 10% cream Capsaicin (0.025%) cream Topical corticosteroid Lidocaine patches
6 causes of pruritis?
Cholestasis, Uraemia, Paraneoplastic, Lymphoma, Systemic opioid induced pruritis
Drugs used to treat the 6 causes of pruritis?
Cholestasis - Rifampicin, Sertraline, Cholestyramine
Uraemia - Gabapentin, Naltrexone, Mirtazapine
Lymphoma - Prednisolone, Cimetidine, Mirtazapine
Systemic opioid-induced - Chlorphenamine, Ondasetron
Paraneoplastic - Paroxetine, Mirtazapine
Unknown- Chlorphenamine, Paroxetine, Mirtazapine
