Pall Care

Question 1

Pain assoc with tumour related oedema

Answer 1

Dexamethasone 4-8mg

or Pred

Question 2

Pain assoc with skeletal muscle spasm

Answer 2

Diazepam

or Baclofen

Question 3

Pain assoc with smooth muscle spasm

Answer 3

Hyoscine butylbromide (Buscopan)
or Hyoscine hydrobromide

Question 4

Bone pain

Answer 4

Radiotherapy +++

Bisphosphonates - zoledronic acid or pamidronate

Question 5

Spinal cord compression

Answer 5

Relieve pain + attempt to decrease size of mass

Dex
Immediate-release opioids
Radiotherapy
IDC

Question 6

SVC obstruction

Answer 6

Regular small doses of immediate release opioid for dyspnoea and headaches
Dex to decrease tumour mass
Radiotherapy
Chemotherapy on occasion

Question 7

Seizures in pall care

Answer 7

Clonazepam or midazolam or phenytoin

Question 8

Pharmacological treatment of anorexia in pall care

Answer 8

Pro-kinetic agents sch as domperidone and metoclopramide are first-line

Question 9

Management of (single site) bowel obstruction in pall care (8)

Answer 9

1. Surgical (resection, stent insertion or bypass of lesion)
2. Reducing parenteral fluids (reduces secretions and consequently the frequency and volume of vomiting)
3. Withdraw stimulant laxatives
4. Avoid using prokinetic antiemetics
5. Reduce volume of gastric secretions with ranitidine
6. Gastric decompression by NGT
7. Dex to reduce tumour oedema
8. Control symptoms of pain, colic. n and v - continuous infusion of analgesics, antispasmodics and antiemetics