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Repro > Palliative > Flashcards

Palliative Flashcards

1
Q

List 4 areas that when triggered can cause N & V

A

Cerebral cortex,
Chemoreceptor trigger zone,
Vestibular centre,
GI tract

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2
Q

What are 4 causes of cerebral cortex related N&V?

A

Emotions,
Sight,
Smell,
Raised ICP

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3
Q

What is 1 cause of vestibular centre related N&V?

A

Motion

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4
Q

What is 2 causes of chemoreceptor trigger zone related N&V?

A

Metabolic caused by sepsis, kidney/liver impairment, advanced cancer
Drugs

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5
Q

What are 5 causes of GI tract related N&V?

A 
GI distension, 
Stasis,
Tumour mass, 
Constipation, 
Radiotherapy
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6
Q

What 3 receptors are associated with cerebral cortex related N&V?

A

Maybe GABA, NK1, 5HT

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7
Q

What 3 receptors are associated with CTZ N&V?

A

D2, 5HT, ACh

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8
Q

What 2 receptors are associated with vestibular centre related N&V?

A

H1, ACh

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9
Q

What 3 receptors are associated with GI tract related N&V?

A

5HT, D2, ACh

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10
Q

List 3 antiemetics for cerebral cortex related N&V

A

dexamethasone, aprepitant, benzodiazepines

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11
Q

List 3 antiemetics that treat CTZ related N&V

A

Haloperidol,
Levomepromazine,
Ondansetron

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12
Q

List 3 antiemetics for vestibular centre related N&V

A

Cyclizine,
Levomepromazine,
Hyoscine

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13
Q

List 4 antiemetics for GI tract related N&V - note, caution in obstruction!

A

Metoclopramide,
levomepromazine,
Ondansetron,
Dexamethasone

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14
Q

What is clinical picture indicating N&V related to cerebral disease? (2)

A

Worse in morning,

Associated headache

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15
Q

What is clinical picture of N&V caused by oncological treatments?

A

Predictable from history,

Often nausea is main complaint

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16
Q

What is clinical picture for N&V caused by impaired gastric emptying?

A

Not usually nauseated then very nauseated,
Large volume vomits,
Feel better after being sick

17
Q

What is the clinical picture for chemical/metabolic related N&V?

A

Persistent nausea with little relief from vomiting

18
Q

What 4 substances are associated with chemical/metabolic N&V?

A

Calcium,
Sodium,
Magnesium,
Urea

19
Q

List some non-pharmacological treatments for N&V

A 
Mouth care, 
Avoid constipation,
Small meals, 
Avoid cooking, 
Acupressure band, 
Acupuncture
20
Q

Malignant bowel obstruction definition

A

Clinical evidence of bowel obstruction in the setting of a diagnosis of intra-abdominal cancer OR non-intra abdo cancer with clear intraperitoneal disease

21
Q

Malignant bowel obstruction can be caused by tumour or benign causes, list 3 benign causes

A

Adhesions, post-radio, constipation

22
Q

MBO occurs in 3-15% of all cancer patients. What two cancers is it particularly common in?

A

Ovarian (most common) and colon cancer

23
Q

Outline causes of MBO

A

MBO can be mechanical (intraluminal, intramural or extramural extrinsic compression) or be caused by adynamic ileus (tumour infiltration of mesentery, muscle or nerves)

24
Q

MBO can be complete or partial - true/false?

A

True

25
Q

OUtline the pathophysiology of obstruction

A

Proximal accumulation of secretions and gut distension
Gut distension causes further secretions alongwith reduced water and sodium absorption, inflammatory gut wall oedema, increased motor activity and increased intra-luminal pressure
Cycle = secretion - distension - secretion

26
Q

List symptoms of MBO

A 
gradual onset over weeks of: 
N&V, 
Pain (continuous/colicky),
Anorexia/thirst, 
Reduced then absent bowel motions/flatus, 
Paradoxical diarrhoea,
Systemic from cancer
27
Q

Management of MBO

A

Drip and suck before surgery,

Surgical: resection, palliative colostomy or ileostomy, self expanding metallic stent

28
Q

Pharmacological option for analgesic for MBO

A

Opioids or hyoscine butylbromide for colicky pain

29
Q

What is important to remember about hyoscine butylbromide?

A

Will slow down bowel

30
Q

Pharmacological option for antiemetic for MBO

A

Metoclopramide 30mg/24hrs if partial/sub-acute obstruction

31
Q

Pharmacological option for steroids for MBO

A

Dexamethasone

32
Q

Pharmacological option for anti-secretory agents for MBO

A

Buscopan or octreotide

33
Q

Pharmacological option for laxative for MBO

A

Docusate or laxido in partial obstruction

34
Q

What is important to remember about pharmacological treatment for MBO

A

Make sure it can be absorbed - N&V patients do not take oral meds

Repro (49 decks)

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