Palliative Care Flashcards

1
Q

Name three major problems that patients in palliative care experience

A

Constipation
Pain
Nausea and vomiting

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2
Q

What are the non pharmacological and pharmacological management options of breathlessness in a patient in palliative care?

A

Non pharmacological: reassurance, relaxation techniques, breathing retraining

Pharmacological: 5-10mg MR oramorph (twice daily)
prescribe concurrent laxative/anti emetic

Benzodiazepines: use only in breathlessness associated with acute panic attacks/anxiety or if patient is imminently dying (500mg lorazepam)

Oxygen therapy

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3
Q

What are the reversible causes of constipation in palliative patients?

A

hypercalcaemia
fluid depletion
side effects of medications

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4
Q

What is the pharmacological management of constipation?

A

1) increase fluids, fruit juices
is stool hard or soft?
hard stool = 1) softener = sodium docusate
soft stool = 1) stimulant = senna

if this hasn’t worked, combine docusate + senna and PR exam

if on PR exam, if;
stool is soft and impacted = bisocodyl
stool is hard and impacted = glycerin suppositories
no stool = high phosphate enema

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5
Q

give examples of stimulant laxatives, their mechanism of action and the dosing

A

senna and bisocodyl
reduces bowel transit time - stimulant
15-30mg at night

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6
Q

give examples of osmotic laxatives, their mechanism of action and the dosing

A

macrogols = movicol
lactulose

retain water in gut lumen which encourages peristalsis

1-3 sachets daily

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7
Q

what are the S.E. of lactulose?

A

bloating
flatulence
abdominal pain

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8
Q

what are the different laxative enemas you can use?

A

arachis oil
microlax
phosphate

all are softener enemas

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9
Q

what are the reversible causes of nausea and vomiting in palliative care?

A

constipation
hypercalcaemia
medication side effects

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10
Q

what is the non pharmacological management of nausea and vomiting in palliative care?

A

provide a calm environment away from where food is prepared
make sure the meals are small and palatable
offer cool, fizzy drinks
consider parenteral hydration
complementary therapies: relaxation techniques

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11
Q

if nausea and vomiting is caused by medication, what anti-emetics would you give?

A

1) haloperidol
2) levomepromazine

(you can tell it is caused by medication as the nausea will be unrelenting, not relieved by vomiting)

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12
Q

if nausea and vomiting is caused by gastric stasis, what anti-emetics would you give?

A

metoclopramide or domperidone

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13
Q

if nausea and vomiting is caused by chemotherapy or radiotherapy, what anti-emetics would you give?

A

acute: ondansetron
delayed: levomepromazine

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14
Q

if nausea and vomiting is caused by organ damage, what anti-emetic should you give?

A

cyclizine

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15
Q

if nausea and vomiting is caused by raised intracranial pressure, what anti-emetic should you give?

A

cyclizine

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16
Q

in postoperative nausea and vomiting, what anti emetic should you give?

A

ondansetron

17
Q

what are the antihistamine anti-emetics, their mechanism of action, and side effects?

A

cyclizine and promethazine

block H1 receptors in the vomiting centre in the medulla. have antimuscarinic properties too.
best for ‘higher neurological’ issues such as meniere’s and vertigo.

SE: sedation, dry mouth, blurred vision, hypotension

an example dose: cyclizine 50mg 8 hourly

18
Q

what is the antimuscarinic anti-emetic?

A

hyoscine hydrobromide

used in motion sickness

19
Q

what are the dopamine receptor antagonist anti-emetics and their side effects?

A

chlorpromazine, metoclopramide, domperidone

act at the chemoreceptor trigger zone blocking dopamine receptors

SE: hyperprolactinaemia, EPS = dystonia, parkinsonism, akathisia, neuroleptic malignant syndrome

20
Q

what are the 5HT3 receptor antagonist anti-emetics, their mechanism of action and side effects?

A

ondansetron

blocks the 5HT3 receptors in the CTZ and gut

side effects: constipation, headache, flushing, QT interval prolongation

21
Q

what are the commonest causes of malignant ascites? what is the treatment of ascites?

A

primary tumours of breast, colon, ovary, stomach, pancreas, bronchus

treatment: paracentesis or spironolactone