Palliative care Flashcards
What are the different grades of the ECOG Performance Status?
0: fully active, able to carry on all pre-disease performance without restriction
1: restricted in physical strenuous activity but ambulatory and able to carry out work of a light or sedentary nature
2: ambulatory and capable of all selfcare but unable to carry out any work activities: up and about more than 50% of waking hours
3: capable to only limited selfcare: confined to bed or chair more than 50% of waking hours
4: completely disabled: cannot carry on any selfcare: totally confined to bed or chair
5: dead
What are the side effects of androgen deprivation therapy?
hot flushes, lowered libido, weight gain
Discuss the physical, social, psychological and spiritual impacts on a patient’s perception of patient.
Physical: pain due to disease, other symptoms e.g. nausea, physical decline and fatigue
Social: relationships, role in family, work, finances
Psychological: grief for lost life/meaning, depression, anxiety, adjustment
Spiritual: existential issues, religion, meaning of life, personal value
What is the difference between nociceptive and neuropathic pain?
Nociceptive: caused by injury, physical pressure or inflammation and detected by nociceptors throughout the body
Neuropathic: caused by damage to peripheral or CNS e.g. diabetic neuropathy
What are the two types of nociceptive pain?
Somatic: pain arising from injury or infiltration of skin, muscles, tendons or bone
Visceral: infiltration, compression, distension of thoracic and abdominal viscera (liver, bowel, heart, pleura)
How do opioids cause constipation?
they inhibit gastric emptying and peristalsis in the GI tract which results in delayed absorption of medications and increased absorption of fluid which leads to hardening of stool and constipation
What are some examples of weak and strong opioids?
Weak: codeine, tramadol, low-dose morphine
Strong: morphine, fentanyl, oxycodone, hydromorphone, buprenorphine
What are some of precipitating factors of opioid toxicity?
rapid dose escalation
renal impairment
sepsis
drug interactions
What is myoclonus?
sudden, brief, involuntary muscle jerks which can be either irregular or rhythmic
What are some of the opioid toxicity?
delirium vivid dreams/nightmares persistent sedation myoclonus peripheral shadows/hallucinations hyperalgesia
Discuss the management of opioid toxicity.
- dose reducing
- switching to alternative opioid
- IV fluids (renal impairment)
- oxygen and naloxone only considered if there is evidence of severe respiratory depression (RR>8)
What are the treatment options for oral candidiasis?
nystatin 1ml QDS 7 days
more extensive: fluconazole 50mg OD 7 days
What symptoms should anticipatory medications manage?
pain shortness of breath agitation nausea and vomiting respiratory secretions
What are some things included in an anticipatory care plan?
preferred place of care
details of next of kin
level of intervention preferred
resuscitation status
What is an anticipatory care plan?
a dynamic record developed over time through an evolving conversation, collaborative interactions and shared decision making. It is a summary of Thinking Ahead discussions between the person, those close to them and the practitioner
Where is the vomiting centre located?
medulla oblongata
What is the chemoreceptor trigger zone?
- located outside blood brain barrier
- base of 4th ventricle, area postrema
- direct connection to vomiting centre
- detects changes the rest of the brain is protected from
What triggers the CTZ?
biochemical: hypercalcaemia, hyponatraemia, renal failure, liver failure
chemical: opioids, antibiotics, iron, SSRI, digoxin, CINV
Discuss the clinical picture of gastric outlet obstruction.
- likely secondary to tumour or hepatomegaly
- intermittent large volume vomit usually gives temporary relief of symptoms
- early satiation
- reflux and hiccups
- often little nausea until immediately before sick
What causes gastric outlet obstruction?1
- delayed gastric emptying: drugs, tumour infiltration, hepatomegaly, ascites
- bowel obstruction
- severe constipation
- pharyngeal stimulation
Where is the vestibular pathway located and what is it responsible for?
- inner ear
- balance and space
- signals via CNVIII to brainstem via vesticular nuclei
What triggers the vestibular pathway?
motion sickness
morning sickness
What type of drug is metoclopramide?
dopamine antagonist
What is the site of action of metoclopramide?
CTZ, GI tract
