Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cancer Care > Palliative Care: Nausea And Vomiting > Flashcards

Palliative Care: Nausea And Vomiting Flashcards

1
Q

N&V is the …..most troublesome symptom for cancer patients

A

Second

Occurs in up to 70% with advanced disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percentage does it affect with non malignant end stage disease?

A

Up to 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Is it true that vomiting even daily, without nausea is usually better tolerated?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nausea and vomiting in palliative care is often multi-factorial, but which are most common?

A

Gastric stasis

Chemical disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What causes are there?

A 
Infection 
Metabolic
Gastric stasis 
GI disturbance
Neurological 
Psychological 
Drug related 
Organ damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What infections can cause N&V?

A 
Gastroenteritis 
Thrush
Pneumonia
UTI
Viral labyrinthitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What metabolic disturbances can cause N&V?

A 
Renal impairment 
Hepatic impairment
Hyponatraemia 
Hypercalcaemia 
Sepsis
Hyperglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What drugs can cause nausea and vomiting?

A 
Opioids
Chemotherapy 
RT
Antibiotics
NSAIDS
Diuretics 
Digoxin 
SSRIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can cause gastric stasis?

A 
Pyloric tumour/nodes
Ascites
Hepatomegaly 
Opioids
Anticholinergics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What GI disturbances can cause N&V?

A

Constipation
Gastritis
Ulceration
Obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What neurological factors can cause N&V?

A

Raised ICP (usually in context of cerebral mets)
Motion sickness
Meningeal disease
Vestibular - related to activation of acetylcholine and histamine (H1) receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What psychological factors can cause N&V?

A

Anxiety
Fear
Pain
Anticipatory nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What percentage will have more than 1 cause ?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is choice of anti emetic decided upon?

A

The probable cause and the mechanism by which the drug acts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What neurotransmitters are implicated in the control of nausea and vomiting?

A 
Acetylcholine (AChm receptor)
Dopamine (D2 receptor)
Histamine (H1 receptor)
Substance P (NK-1 receptor)
Serotonin (5HT3 or 2 receptors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can vomiting also be referred to as?

A

Emesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What symptoms are associated with emesis?

A 
Profuse salivation
Sweating
Tachycardia 
Pallor 
Nausea 
Retching movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How are the contents of the stomach expelled?

A

The stomach, oesophagus and their sphincters are relaxed during vomiting. Most of the expulsion force arises from the contraction of the diaphragm and the abdominal muscles .

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where is the chemoreceptor trigger zone located in the brain?

A

Medulla - specifically the area postrema (on the floor of the fourth ventricle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Is the CTZ in or outside the BBB?

A

Outside - so emetic toxins in blood can reach it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the role of the chemoreceptor trigger zone?

A

Respond to various stimuli - toxins and drugs in the blood

Communicate with the vomiting centre, which initiates emesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Where is the vomiting centre found?

A

Within medulla (has a BBB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which cancer chemotherapy agents are highly emetic?

A

Cisplatin
Cyclophosphamide
Adriamycin

24
Q

What receptors are located at the CTZ?

A

D2
NK1
5HT3

25
Q

What receptors are located at the vomiting centre?

A

AChm
H1
5HT2
NK1

Also mu receptors

26
Q

How does CNVIII interact?

A

It has AChm and H1 receptors

Communicates with CTZ and vomiting centre

27
Q

How does Haloperidol work?

A

A potent D2 antagonist

Widely used in context of chemical causes of nausea and vomiting

28
Q

What are the features of chemical associate nausea and vomiting?

A

Persistent, often severe nausea
Unrelieved by vomiting
Aggravated by sight/smell of food, drowsiness/ confusion

29
Q

What anti emetics are best for chemical causes?

A

Haloperidol
Metoclopramide
Ondansetron

30
Q

Metaclopramide acts on what receptors?

A

D2 and 5HT3

Helps in those with delayed stomach emptying and GORD

31
Q

What anti emetics are best for gastric stasis?

A

Pro kinetics
- they are often D2 antagonists

E.g metaclopramide or domperidone

32
Q

Domperidone acts at what receptor ?

A

D2

33
Q

What are the features of gastric status nausea and vomiting?

A 
Fullness and regurgitation
Reduced appetite
Vomiting large volumes relives nausea
Epigastric discomfort 
Hiccups
34
Q

How does cyclizine work?

A

H1 antagonist

ACh antagonist

35
Q

What antiemetics are good for bowel obstruction?

A

Cyclizine - slows peristalsis

Dexamethasone - reduces oedema

36
Q

What does NICE suggest to use for raised intracranial pressure induced N&V?

A

Cyclizine

Dexamethasone also used

37
Q

What features are associated with raised ICP associated N&V?

A

Nausea worse in morning
Projectile vomiting
Worse on head movement
Headache

38
Q

What anti emetic is best for vestibular causes?

A

Cyclizine

Refractory cases: prochlorperazine

39
Q

What can be used if anticipatory nausea is the clear cause?

A

Short acting benzodiazepine e.g lorazepam

If benzodiazepines not ideal - cyclizine

40
Q

What is Aprepitant?

A

An anti emetic that works by blocking substance P from acting at NK1 receptors
Acts mainly centrally

41
Q

What is aprepitant used for?

A

Emetogenic chemotherapy

42
Q

What is frequently cited as the most distressing side effects of chemotherapy?

A

Nausea and vomiting

43
Q

CINV has increased risk associated with what?

A

Specific chemo agents
Female gender
Age less than 50
Past history of nausea and vomiting - pregnancy, motion sickness, prior chemotherapy use

44
Q

What types of CINV are there?

A

Acute
Delayed
Anticipatory

45
Q

What side effects of aprepitant are there?

A

Constipation

Headache

46
Q

CINV consists of an acute and delayed phase. Acute phases emesis responds well to …

A

5HT3 antagonists e.g ondansetron

Delayed phase remains difficult to control (but the discovery of NK1 antagonists helped as they elicit anti emetic effects in acute and delayed)

47
Q

When is ondansetron used?

A

Chemotherapy, radiotherapy or surgery

No effect on vomiting caused by motion sickness

Only 5HT3 effect

48
Q

How does hyoscine work?

A

Anticholinergic

Very sedating

49
Q

When is hyoscine used?

A

Motion sickness
Post op nausea and vomiting
May be used pre surgery to reduce saliva
Bowel obstruction

50
Q

Control of symptoms using one anti emetic is possible in what percentage of patients?

A

60%

1/3 required second antiemetic - combine antiemetics with different mechanisms of action

51
Q

What route is generally preferred?

A

Oral absorption likely to be poor, so consider SC for at least 24 hours

Switch to oral if improving

52
Q

What non pharmacological measures can be tried?

A

Smells that patient likes
Small, appropriate meals
Acupuncture ?

53
Q

What is levomepromazine typically used for?

A

Low potency antipsychotic
Analgesic, antiemetic and hypnotic properties
Primarily used in palliative care

“Dirty drug” - blocks a variety of receptors: D2, 5HT2, H1, ACH

54
Q

Why is dexamethasone useful?

A

Reduces permeability of BBB to emetogenic substances

Improves effects of other anti emetics including NK1 antagonists, 5HT3 and metaclopramide

55
Q

Why are seratonin antagonists useful in CINV?

A

Following chemotherapy there is a huge release of serotonin from enterochromaffin cells in bowel wall

56
Q

What would be the first choice in pregnancy associated nausea and vomiting?

A

Cyclizine - greater experience with them and not thought to be teratogenic

57
Q

What are the side effects of cyclizine?

A

Sedation

Dry mouth, blurry vision, urinary retention

Cancer Care (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions