Palliative Care Flashcards
When should a patient be treated as neutropenic sepsis?
Temperature above 38 and neutrophils below 1
How long after chemotherapy is neutropenic sepsis likely?
Within 6 weeks
What is the time limit for when a patient with suspected neutropenic sepsis should receive antibiotics?
Less than 1 hour since arrival
What is an appropriate antibiotic for neutropenic sepsis?
IV tazocin (can switch to oral after 24-48 hours)
What are the symptoms of metastatic spinal cord compression (MSCC)?
Worsening back pain, limb weakness, sensory loss, bowel and bladder dysfunction
What are the causes of MSCC?
Vertebral metastases, soft tissue mass or retropulsed bony fragment due to fracture
What is the investigation of choice in MSCC?
MRI whole spine with gadolinium enhancement
What is the initial management of MSCC?
Dexamethasone 8mg BD (monitor BM and give PPI)
What is the definitive management of MSCC?
Surgical decompression (if single site)
Radiotherapy (if multiple sites)
Why do cancer patients develop hypercalcaemia?
Bone metastases, dehydration or production of ectopic PTH
What are the symptoms of hypercalcaemia?
Abdominal pain, vomiting, constipation, polyuria, polydipsia, fatigue, weakness, confusion, depression
What investigations need to be done in metastatic hypercalcaemia?
Imaging for bone mets, ECG to look for shortened QT interval
What is the management of hypercalcaemia?
Rehydrate 4-6L of 0.9% saline
Bisphosphonates IV (e.g. zolendronic acid)
Manage cause if possible
What are the signs of SVC obstruction?
Dilated veins, oedema, severe respiratory distress, cyanosis, neck and face swelling, cough
What is the definitive investigation in SVC obstruction?
CT thorax
What is the management of SVC obstruction?
High dose steroids, endovascular stenting
When is ondansetron a good antiemetic?
Chemotherapy and radiotherapy related N+V, post op N+V
What are the contraindications for ondansetron?
Prolonged QT
When is metoclopramide a good antiemetic?
Useful in decreased gut motility such as opioids
What are the contraindications for metoclompramide?
Parkinson’s (use domperidone instead), GI obstruction
What is the antiemetic choice for hypercalcaemia?
Haloperidol
When is cyclizine a good antiemetic to use?
Motion sickness, vertigo, bowel obstruction
When should cyclizine be avoided?
In elderly patients due to anticholinergic side effects
How is capillary bleeding managed?
Tranexamic acid
How is dry mouth managed?
Artificial saliva and good mouth care
How is oral thrush managed?
Nystatin and fluconazole
How is breathlessness managed?
Oral morphine or diazepam
How is dysphagia cause by obstruction managed?
Dexamethasone
How is bowel colic treated?
Loperamide or hyoscine butyl bromide
How is abdominal distention/hiccups managed?
Antacids, antiflatulent and domperidone
How are fungating tumours managed?
Metronidazole and regular dressings
How are excessive respiratory secretions managed?
Hyoscine buytl bromide
How is raised ICP managed?
Dexamethasone
How is restlessness/confusion managed?
Haloperidol or levomepromazine
How is intractable cough managed?
Moist inhalations and regular oral morphine
How is bone met pain managed?
Radiotherapy and bisphosphonates
How is neuropathic pain managed?
TCA, anti-epileptics, ketamine
What 4 medications are commonly found in anticipatory prescriptions?
Morphine or some form of opioid pain relief
Levomepromazine (or other antiemetic)
Midazolam (for agitation/restlessness)
Hyoscine butylbromide (for respiratory secretions)
