Palliative care Flashcards
Causes of reduced gastric motility linked vomiting and nausea in palliative care
May be opioid related
Related to serotonin(5HT4) and dopamine(D2) receptors
Causes of chemically mediated nausea and vomiting
Hypercalcaemia
Opioids
Chemotherapy
Visceral/serosal causes of nausea and vomiting
Constipation
Oral candidiasis
Vestibular causes of nausea and vomiting
Related to activation of acetylcholine and histamine (H1) receptors
Most frequently in palliative care is opioid related
Can be motion related, or due to base of skull tumours
Cortical causes of nausea and vomiting
May be due to anxiety, pain, fear and/or anticipatory nausea
Related to GABA and histamine (H1) receptors in the cerebral cortex
management of chemically mediated nausea and vomiting
Ondansetron
Haloperidol
Mx of visceral/serosal nausea and vomiting
Cyclizine and levomepromazine
Anti-cholinergics such as hyoscine may be useful
Mx of raised ICP linked nausea and vomiting
Cyclizine
Dexamethasone
Radiotherapy if cranial tumours
Management of anticipatory nausea
Lorazepam
When are oral anti-emetics not suitable
Vomiting
Malabsorption
Severe gastric stasis
What should be co-prescribed with opioids for pain relief
Laxatives
Nausea if often transient but antiemetic can be offered
Breakthrough dose of morphine
1/6th daily dose of morphine
Preferred opioid in mild-to-moderate renal impairment
Oxycodone
Preferred pain relief in severe renal impairment
alfentanil, buprenorphine and fentanyl are preferred
Mx of metastatic bone pain
strong opioids, bisphosphonates or radiotherapy
Referral to oncology
Mx of hiccups
Chlorpromazine in intractable hiccups
Halperidol, gabapentin also used
Dexamethasone if hepatic lesions
First line mx of agitation and confusion
Haloperidol
other options - chlorpromazine
Management of excessive secretions in terminal stage of life
Hyoscine hydrobromide
Glyopyrronium bromide may also be used
When should syringe drivers be considered
hen a patient is unable to take oral medication due to nausea, dysphagia, intestinal obstruction, weakness or coma
Definition of neutropenic sepsis
defined as a neutrophil count of < 0.5 * 10^9 in a patient who is having anticancer treatment and has one of the following:
a temperature higher than 38ºC or
other signs or symptoms consistent with clinically significant sepsis
Prophylaxis in neutropenic sepsis
if it is anticipated that patients are likely to have a neutrophil count of < 0.5 * 109 as a consequence of their treatment they should be offered a fluoroquinolone
Mx of neutropenic sepsis
Tazocin immediately
May be a role for G-CSF in selected patients
Four main classes of meds for anticipatory end of life prescribing
Analgesia: for pain
Anti-emetic: for nausea and vomiting
Anxiolytic: for agitation
Anti-secretory: for respiratory secretions
Conversion of oral morphine sulphate to fentanyl patch
25 mcg/hr fentanyl patch = 60mg oral morphine
Morphine oral to subcut conversion
Half to convert to SC
Causes of nausea in a patient with advanced lung cancer
Constipation Chest infection Liver mets Brain mets Hypercalcaemia
Treatment of nausea and vomiting due to raised ICP
Dexamethasone, cyclizine
Mx of nausea and vomiting in renal failure
Haloperidol
Mx of nausea and vomiting in opioid induced nausea
Metoclopromide, domperidone and haloperidol
Non-drug measures for management of dyspnoea
Fan, air circulation, open windows
Positioning
Breathing exercises
Relaxation techniques
What allows for detainment of people under MCA
DOLS
Does MCA require mental health disorder
No
What is an advanced decision to refuse treatment
Verbal statement that has to be in writing to have legal relevance
Can only be overridden if another individual has LPA for health and welfare
