Palliative Flashcards
Causes of N&V
Chemo Constipation GI obstruction Drugs Pain Infection
Why shouldn’t you prescribe cyclizine and metoclopramide?
Metoclopramide (D2) is a prokinetic and can cause diarrhoea
Cyclizine (H1, antiMusc) is constipating
H1 receptor anti emetic
Cyclizine - GI causes
D2 receptor anti emetic
Metaclopramide - GI causes - Also prokinetic
Domperidone - Also prokinetic
Prochlorperazine - Vestibular/GI
Haloperidol - Chemical causes - Opioids
5HT anti emetic
Ondansetron
Levomepromazine
Alternative broad spec anti emetic with sedative effect
Common symptoms in palliative care
Pain Nausea & Vomiting Constipation Breathlessness Agitation Oral infections/secretions
PRN Meds
Pain - Diamorphine Agitation - Midazolam N&V - Haloperidol - Also agitation and hallucinations Resp secretions - Hyoscine hydrobromide Constipation - Lactulose
Breathlessness
Morphine & Benzos
Why use Dexamethasone in palliative care
May relieve symptoms for SVC and Bronchial obstruction, ICP headache and good for euphoria
Naproxen
Good for fevers from metastasis & bone pain
5 principles to good pain management
- By the mouth - Whenever possible
- By the clock - Regular meds for continuous pain
- By the ladder - Move up the WHO pain ladder
- For the individual - Does vary
- Attention to detail - Look for side effects.
Pain ladder
Paracetamol, NSAID
Codeine, tramadol
Morphine, diamorphine, oxycodone, buprenophine
Methadone, Ketamine
Adjuvant drugs (6)
Antidepressant - Neuropathic pain e.g. amitryptilline
Anti Epileptic - Neuropathic pain e.g. pregabalin, gabapentin
Antispasmodics - Muscle spasms e.g. baclofen
Steroids - Compression symptoms e.g. dexamethasone
Benzodiazepines - Spasms e.g. clonazepam, diazepam
Bisphosphonates - Bone pain e.g. zolendronic acid
Effect of opioids on breathing
reduce RR BUT increase tidal volume
