Palliative Flashcards
List 4 areas that when triggered can cause N & V
Cerebral cortex,
Chemoreceptor trigger zone,
Vestibular centre,
GI tract
What are 4 causes of cerebral cortex related N&V?
Emotions,
Sight,
Smell,
Raised ICP
What is 1 cause of vestibular centre related N&V?
Motion
What is 2 causes of chemoreceptor trigger zone related N&V?
Metabolic caused by sepsis, kidney/liver impairment, advanced cancer
Drugs
What are 5 causes of GI tract related N&V?
GI distension, Stasis, Tumour mass, Constipation, Radiotherapy
What 3 receptors are associated with cerebral cortex related N&V?
Maybe GABA, NK1, 5HT
What 3 receptors are associated with CTZ N&V?
D2, 5HT, ACh
What 2 receptors are associated with vestibular centre related N&V?
H1, ACh
What 3 receptors are associated with GI tract related N&V?
5HT, D2, ACh
List 3 antiemetics for cerebral cortex related N&V
dexamethasone, aprepitant, benzodiazepines
List 3 antiemetics that treat CTZ related N&V
Haloperidol,
Levomepromazine,
Ondansetron
List 3 antiemetics for vestibular centre related N&V
Cyclizine,
Levomepromazine,
Hyoscine
List 4 antiemetics for GI tract related N&V - note, caution in obstruction!
Metoclopramide,
levomepromazine,
Ondansetron,
Dexamethasone
What is clinical picture indicating N&V related to cerebral disease? (2)
Worse in morning,
Associated headache
What is clinical picture of N&V caused by oncological treatments?
Predictable from history,
Often nausea is main complaint
What is clinical picture for N&V caused by impaired gastric emptying?
Not usually nauseated then very nauseated,
Large volume vomits,
Feel better after being sick
What is the clinical picture for chemical/metabolic related N&V?
Persistent nausea with little relief from vomiting
What 4 substances are associated with chemical/metabolic N&V?
Calcium,
Sodium,
Magnesium,
Urea
List some non-pharmacological treatments for N&V
Mouth care, Avoid constipation, Small meals, Avoid cooking, Acupressure band, Acupuncture
Malignant bowel obstruction definition
Clinical evidence of bowel obstruction in the setting of a diagnosis of intra-abdominal cancer OR non-intra abdo cancer with clear intraperitoneal disease
Malignant bowel obstruction can be caused by tumour or benign causes, list 3 benign causes
Adhesions, post-radio, constipation
MBO occurs in 3-15% of all cancer patients. What two cancers is it particularly common in?
Ovarian (most common) and colon cancer
Outline causes of MBO
MBO can be mechanical (intraluminal, intramural or extramural extrinsic compression) or be caused by adynamic ileus (tumour infiltration of mesentery, muscle or nerves)
MBO can be complete or partial - true/false?
True
OUtline the pathophysiology of obstruction
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
List symptoms of MBO
gradual onset over weeks of: N&V, Pain (continuous/colicky), Anorexia/thirst, Reduced then absent bowel motions/flatus, Paradoxical diarrhoea, Systemic from cancer
Management of MBO
Drip and suck before surgery,
Surgical: resection, palliative colostomy or ileostomy, self expanding metallic stent
Pharmacological option for analgesic for MBO
Opioids or hyoscine butylbromide for colicky pain
What is important to remember about hyoscine butylbromide?
Will slow down bowel
Pharmacological option for antiemetic for MBO
Metoclopramide 30mg/24hrs if partial/sub-acute obstruction
Pharmacological option for steroids for MBO
Dexamethasone
Pharmacological option for anti-secretory agents for MBO
Buscopan or octreotide
Pharmacological option for laxative for MBO
Docusate or laxido in partial obstruction
What is important to remember about pharmacological treatment for MBO
Make sure it can be absorbed - N&V patients do not take oral meds
