Palliation of symptoms Flashcards
Anorexia / loss of appetite
very common
often a major source of distress
fatigue
disease treatment concurrent illness anaemia unrelieved symptoms cachexia / malnutrition depression physical de-conditioning
dyspnoea
opioids can be helpful
benzos for anxiety / panic
opioids:
diamorphine 5-10mg/24hr sc via SD
benzodiazepines
midazolam 5-30mg/24hr via SD and 2.5-5mg sc pm
nausea and vomiting
vestibular nuclei
- h1 receptor antagonist
- muscarinic receptor antagonist
CTZ (D2 and HT3 receptors)
- dopamine antagonist
- 5HT3 anagonist
vomiting centre
- muscarinic receptor antagonist
visceral afferents
- 5HT3 antagonist
emetic pathways
motion sickness to labyrinth to vestibular nuclei
pain/repulsive sight/smell/emotion to sensory afferent pathways = higher centres = vomitin centres
endogernous toxins or drugs in blood, release of emetogenic agents (prostanois, free radicals) to CTZ and visceral afferents = nucleus of soliatry tract = vomiting cnetre
stimuli from pharynx and stomach = visceral afferent = vomiting centre
nausea and vomiting
prokinetic antiemetics (gastric stasis, peristaltic failure)- *metoclopramide, *domperidone
acting at CTZ (chemical causes)
*haloperidol
acting on the vomiting centre (raised intracranial pressure, vestibular causes, bowel obstruction)
*cyclizine H1
nausea and vomiting management
reversible causes (calcium)
route (syringe driver)
rehydration
metoclopramide +/- levomepromazine
dexamethasone
constipation mx
screen and monitor
anticipate and titrate laxatives
soften and push
peripheral opioid antagonist like methylnaltrexone, naloxegol
ubiquitous dexamethasnoe
Tumour compression spinal cord compression SVCO bronchial/tracheal bowel obstruction Cerebral oedema Pain neuropathic liver capsule radiotherapy flare Nausea Appetite / well being
2mg-16mg/day
look out for:
Glucose intolerance (BM peak late afternoon)
Proximal myopathy
Agitation / psychosis (occasionally)
Gastritis (but most patients already on PPIs)
buscapan
(smooth muscle spasm, anti secretory)
Colic / reduce volume of vomits in bowel obstruction
Reduce salivary secretions (? evidence) (also glycopyrronium, hyoscine hydrobromide)
octreotide
anti secretory)
Reduce volume of vomits in bowel obstruction
High output fistulae
baclofen
Muscle spasm
Hiccups
midazolam
Anxiety, breathlessness, seizures, pain crises
meds
secretions- glycopronium, hyoscine
breathless- opioid, benzodiazepines
physiological changes in death
increase weakness fatigue loss of ability to close eyes decrease appetite/fluid intake/oral meds decrease blood perfusion neurological dysfunction pain