palliative care Flashcards
bone pain
dull ache over large area or well localised tenderness over bone often worse at night
TX - NSAIDS
radiotherapy and bisphosphonates
visceral pain
dull deep seated poorly localised/ may be pain over particular organ, some is spasmodic e.g. bladder spasm
TX - visceral stretch = NSAID
colic pain - Anticholinergics such as hyocine butyl bromide
raised ICP
dull oppressive pain worse on walking coughing sneeezing - associated with N+V
TX- corticosteroids to reduce oedema, NSAIDs, paracetamol
Neuropathic pain
abnormal sensation, may be localised to specific dermatome and present as altered sensation such as numbness or hyperaesthesia and autonomic changes- pallor/sweating
TX- antidepressant (amitrypti;ine)
Anticonvulsant (gabapentin)
Corticosteroids - helpful in nerve compression
bulk forming laxative
fybogel - adds fibre
softener = osmotic laxative
lactulose- sweet lactose draws h20 into bowel
Docusate
(water makes poo more soft)
stimulant
senna (fast car - stimulating fast)
- supposatry
- -> faecal impaction
- -> overflow diarrhoea
Mixed stimulant and softener
- co-danthrusate
- Movicol - I like to moveit move it = double action
N+V FROM toxicity
haloperidol
remember as haloperidol for psychosis = likey to get TOXIC overdoses
N+V from gastric stasis
Metoclopramide
N+V from raised ICP
dexamethasone
N+V from anxiety
Benzodiazepines
N+V unsure cause
Levomepromazine
N+V vestibular cause
Cyclizine
“cycle” spins rounds lots- dizzy- vestibular
ANTICIPATORY MEDS
Anxiolytics-> midazolam
Antiemetics -> haloperidol / ondansetron/ Levorpomazine
Antisecretory -.> hyocine butyl bromide
Analgesic : morphine
drugs too irritant for subcut administration
Diazepam
Chlorpromazine
Prochlorperazine
signs of impending death
death rattle = noise due to increased secretions
terminal restlessness
seizures and haemorrhage
tumour lysis
cause
markers
large number of cells are killed quickly via chemo
- -> release intracellular ions into systemic circulation
- patient develops hyperURICAEMIA, hyperkalaemia, high phosphate, decreases calcium + acute renal impairment
syx: vague abdo pain, dizziness, vomiting, seizures, heart failure
tx: IV HYDRATION
CARDIAC MONITORING
ALLOPURINOL to decrease uric acid levels
- sometimes needs dialysis
