N/V/C Malignant BO Flashcards
In the terminal phase, is a dry mouth indicative of the need for parenteral fluid?
No - relationship between not clear (b/w dehydration and thirst). Sensation of thirst related to sensation dryness of the mouth.
Mx dry mouth in palliative stages?
- Ask pt if dry mouth
- inspect oral cavity for inflammation, debris and infection
What are the cause of xerostomia?
- Damage to salivary glands (RT, surgery, infection)
- Medications (TCAs, antihistamines, anti cholinergics)
- Mouth breathing
How is xerostomia managed?
Meticulous mouth care
What is involved in mouth care?
- Frequent (2h) mouth washes with water
- Bioetene products (mouthwash, toothpaste)
- Moisten oral cavity with sips of fluid / plain water sprays
- Gentle teeth brushing
- Lanolin based balm to lips
What are biotene products?
Formulations of enzymes found normally in human saliva
What is stomatitis?
Inflammation of mouth or lips
Causes of stomatitis?
- Xerostomia
- RT
- Chemotherapy
- Infections (fungal, bacterial, viral)
Mx stomatitis?
Symptomatic and Rx cause -General mouth care -systemic or topical oral antifungals >nystatin 100000U/mL 1mL >fluconazole 50-100mg PO OD x3/7
When is metoclopramide contraindicated?
Suspected bowel obstruction
Rx N/V secondary to poor gastric emptying?
-Metoclopramide 10mg PO QID
OR
-domperidone 10mg PO QID
Mx hyperacidity (i.e reflux) causing N/V?
- Simple antacids if occasional
- PPI e.g. omeprazole 20mg PO daily
Rx N/V due to CTZ causes?
- Haloperidol 0.5-2.5mg PO or SC BD; max 7.5
- Metoclopramide 10-20mg PO QID
- Prochlorperazine 5-10 PO TDS
How do drugs used to Mx CTZ N/V act? Uses?
i.e. Halo, Metoclopramide and prochlorperazine.
-inhibit dopamine in CNS
SEs:
-drowsiness
-postural hTN
-akathisia
-extrapyramidal Sx (e.g. acute dystonia)
Rx vestibular cause N/V?
Prochlorperazine 5-10mg orally TDS-QID OR Haloperidol 0.5-2.5mg orally BD Poor response, ADD -Promethazine -Cyclizine
Rx N/V a/w anxiety?
- Alprazolam .125-5 6h
- Lorazepam 0.5-1 6h
Mx N/V secondary to raised ICP?
Dexamethasone 8-16mg PO
PLUE
-haloperidol 0.5-2.5 BD
Mx chemotherapy/RT associated N/V?
5-HT3 antagonist e.g. ondansetron 4mg PO BD
Constipation prophylaxis?
- Encourage regular toileting
- Ensure adequate hydration and fibre
- Encourage general activity through control of other symptoms
- Treat any cause (i.e. lack of privacy, pain, poor mobility)
In which patients do bulk forming agents have no role?
- Patients taking opioids
- Nonambulant patients
What must be prescribed with opioids?
The hand that writes the opioid order must also write the aperient order.
Constipation prophylaxis in PC patients?
Prophylactic lax best = faecal softening agent and bowel stimulant
docusate + sennoside B 100+ 16 mg (= 2 tablets) orally, once or twice daily.
Mx difficulty expelling soft stool?
Propulsive stimulant agent
Bisacodyl 10 mg (=2 tablets) orally, at night, increasing to a maximum of 10 mg twice daily
What are the causes of bowel obstruction in palliative cancer patients?
- Instrinsic (e.g. CRC 1”)
- Extrinsic compression (e.g. pancreatic Ca)
- Peristaltic dysfunction (e.g. ovarian Ca)
medical Mx of bowel obstruction (after exclusion of surgically reversible cause)?
- Reduce parenteral fluids
- Withdraw stimulant laxatives (senna and bisacodyl)
- avoid pro kinetic anti emetics (metoclopramide, domperidone)
- control sx of pain, N/V: analgesics, anti-spasmodics, anti-emetics
- reduce volume of gastric secretions with ranitidine
- gastric decompression (NGT, gastrostomy)
Mx colic malignant BO?
hyoscine butylbromide (Buscopan) 60 to 80 mg/24 hours (initially) by continuous SC infusion, and titrate to effect (to a maximum of 120 mg/24 hours).
What are the mechanisms of opioid induced nausea and vomiting?
- Contipation
- Gastroparesis
- CTZ stimulation
- Labyrinth sensitisation
when is methylnaltrexone indicated?
mx severe constipation used if rectal preparations are ineffective or hazardous (e.g. neutropenic from chemotherapy)
