Palliation of symptoms Flashcards

1
Q

Anorexia / loss of appetite

A

very common

often a major source of distress

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2
Q

fatigue

A
disease
treatment
concurrent illness
anaemia
unrelieved symptoms
cachexia / malnutrition
depression
physical de-conditioning
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3
Q

dyspnoea

A

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

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4
Q

nausea and vomiting

A

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

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5
Q

emetic pathways

A

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

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6
Q

nausea and vomiting

A

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

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7
Q

nausea and vomiting management

A

reversible causes (calcium)

route (syringe driver)

rehydration

metoclopramide +/- levomepromazine

dexamethasone

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8
Q

constipation mx

A

screen and monitor
anticipate and titrate laxatives
soften and push
peripheral opioid antagonist like methylnaltrexone, naloxegol

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9
Q

ubiquitous dexamethasnoe

A
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)

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10
Q

buscapan

A

(smooth muscle spasm, anti secretory)
Colic / reduce volume of vomits in bowel obstruction
Reduce salivary secretions (? evidence) (also glycopyrronium, hyoscine hydrobromide)

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11
Q

octreotide

A

anti secretory)
Reduce volume of vomits in bowel obstruction
High output fistulae

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12
Q

baclofen

A

Muscle spasm

Hiccups

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13
Q

midazolam

A

Anxiety, breathlessness, seizures, pain crises

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14
Q

meds

A

secretions- glycopronium, hyoscine

breathless- opioid, benzodiazepines

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15
Q

physiological changes in death

A
increase weakness
fatigue
loss of ability to close eyes
decrease appetite/fluid intake/oral meds
decrease blood perfusion
neurological dysfunction
pain
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16
Q

physiological changes in death

A
increase weakness
fatigue
loss of ability to close eyes
decrease appetite/fluid intake/oral meds
decrease blood perfusion (tachycardia, hypotension, mottling of skin, diminished UO)
neurological dysfunction
pain
17
Q

2 roads to death

A

sleepy, lethargic, obtunded, bed bound, semicomatose, comatose.

18
Q

meds for terminal delerium

A
benzodiazepines
lorazepam
midazolam
haloperidol
levompromazine
seizures.
19
Q

changes in respiration

A
altered breathing patterns
diminished tidal volume
apnoea
Cheyenne stokes resp
accessory muscle use 
alas reflex breath
20
Q

death rattle

A
glycoperonium
hyoscine (2 types= buscapan which does not cross BBB and does not cause sedatoin or agigtation) (hyoscine hydrobromide- patches, does cross the BBB)

postural drainage
positioning
suctionign

21
Q

death rattle

A
glycoperonium
hyoscine (2 types= buscapan which does not cross BBB and does not cause sedation or agitation) (hyoscine hydrobromide- patches, does cross the BBB)

postural drainage
positioning
suctioning

22
Q

TEP and CPR

A

would the patient survive? yes / no

discuss good dying, why CPR not being offered, why inappropriate, obtained informed decision.