Palliating other symptoms Flashcards
What non- drug approaches can be taken to improve breathlessness?
- position patient upright
- airflow across face e.g fan or open window
- only give O2 if hypoxic
- physio/ OT
How do you treat breathlessness than hasn’t responded to non-drug approaches?
- Consider low dose morphine e.g.
- Oramorph 1-2mg orally PRN
- morphine 1-2mg SC PRN
If there’s a lot of anxiety related to breathless consider lorazepam or midazolam
- Lorazepam 0.5mg-1mg SL PRN
- Midazolam 2.5mg SC PRN
Where does Haloperidol act?
D2 receptors in CTZ
Where does Metoclopramide act?
D2 receptors in CTZ
5 HT3 receptors vagus afferent
Where does Cyclizine act?
ACh receptors and H1 receptors in vomiting centre
Where does levomepromazine act?
D2 receptors in CTZ
5HT3 receptors in vomiting centre
ACh receptors and H1 receptors in vomiting centre
Where does ondansetron act?
5HT3 receptors in vagus afferent
Which would be the best anti-emetic for chemical causes of N+V?
Haloperidol
Which would be the best anti-emetic for N&V caused by gastric stasis?
Metoclopramide
Which would be the best anti-emetic for functional bowel obstruction
Cyclizine (slows peristalsis to reduce perforation)
plus Dexamethosone can help if due to oedema
What would be the best anti-emetic for N+V caused by raised ICP/ intracerebral cause
Cyclizine + Dexamethasone
What would be the best drug to help with N+V caused by anxiety / fear / anticipation?
Benzodiazepines
Which would be the best anti-emetic for post operative / radiotherapy N+V?
Ondansetron - rarely used 1st line in cancer patient
What is the best way to manage N+V caused by constipation?
Laxatives + metoclopramide
What are some of the risk factors for chemotherapy induced N+V
- female
- <50 yrs old
- past history of N&V(in pregnancy/ motion sickness)
Which drug can be used for those high risk of developing N&V before starting chemotherapy?
Aprepitant
Normally taken night before / morning of
Usually only taken at the beginning of the cycle
Which laxatives are stimulants?
Senna
Bisacodyl
Which laxatives are stool softeners?
Docusate
Which laxatives are stool softeners / stimulants
Sodium picosulfate
Which laxatives are osmotic?
Movicol
Laxido
(Lactulose too but tends not to be used in oncology)
Name a softening suppository
Glycerin
Name a stimulant suppository
Bisacodyl
How is malignant bowel obstruction managed surgically?
- Endoscopic stenting
- Venting gastrostomy to decompress
- Avoid NG if possible
How is malignant bowel obstruction managed if not a surgery candidate?
SC dexamethasone injections together with opioid analgesia, cyclizine and octreotide delivered over 24 hours via a subcutaneous syringe driver.
- Limit oral fluids to sips = give IVF
- Correct any electrolyte imbalance
- NG tube for large volumes of vomiting
