Palliative Care Flashcards
Describe the WHO pain ladder
- non opiod +/- adjuvant
- Mild opioid +/- non opiod +/- adjuvant
- Strong opioid +/-nonopiod +/- adjuvant
give examples if mild opiates
codeine, tramadol, dihydorcodeine
give examples of strong opiods
diamorphine
morphine
fentanyl
oxycodone
what is the CTZ
chemoreceptor trigger zone - receives inputs from blood-borne drugs or hormones, and communicates with other structures in the vomiting center to initiate vomiting
where is the CTZ locate
on the floor of the fourth ventrical in the medulla
What neurotransmitters are involved in vomiting
dopamine 5HT NK1 GABA Ach Opioid
what are the characteristics of vomiting due to impaired gastric emptying
not usually nauseated - then suddenly very nauseated - large volume vomits - feels better after vomit
5HT/D2 mediated
What are the characteristics of regurgitation vomiting
due to obstruction or compression of the oesophagus - dysphagia, pain, coughing, stridor
5HT/D1 mediated
What are the characteristics of chemical/metabolic reasons for vomiting
persistant nausea, little relief from vomiting
(calcium, sodium and urea raised)
CTZ/D1/NK - CTZ mediated
GABA/NK1 - cerebral
characteristics of bowel obstruction vomiting
intermittent large vomits, colic, reduced bowel movements
5HT/D2 = gut mediated
characteristics of vomitning due to cerebral disease
worse in morning, headache
GABA/H1/NK1 - cerebral
characterisitcs of vestibular vomiting
worse on movement, vertigo, tinnitus
Ach/H1 - vestibular
What type of vomiting does oncological treatments produce
Cerebral - GABA/NK1
CTZ- 5HT/d2
treatment of vomiting due to impaired gastric emptying
metoclopramide
domperidone
treatment of regurgitation vomiting
dexamethasone
treatment of chemical/metabolic vomiting
haloperidol
metoclompramide
levomepromazine
treatment of vomiting due to cerebral disease
dexamethasone
cyclizine
treatment of vestibular vomiting
cyclizine
prochlorperazine
treatment of vominting due to oncological treatments
ondansetron
metoclopramide
dexamethasone
lorazepam
Which part of the bowel is more commonly obstructed in malignant bowel obstruction
small intestine> large
name drugs that are used as anti secretory agents
hyoscine butylbromide (buscopan) octreotide
how does octreotide work
it is a sommatostatin analogue - inhibits GI secretions
NAME some stool softeners
sodium docusate
movicol
what laxative should be used if the patient has refractory opioid induced constipation
methylnatrexone
how should medications generally be delivered in palliation
parenteral not oral
