Palliative care (Yr 4)

Question 1

what is palliative care?

Answer 1

relieving pain without dealing with the cause of the condition, improving quality of life for patients facing life-threatening illness

Question 2

is euthanasia considered palliative care?

Answer 2

yes, this is the end stage of palliative care

Question 3

what is quality of life?

Answer 3

individuals satisfaction with its physical/psychological health along with its ability to interact socially and physically with the environment

Question 4

how can pain be recognised?

Answer 4

physical response (vocalisation, response to palpation…)
measurable (heart rate, appetite change…)
activity, gait, posture
attitude, expression

Question 5

why are NSAIDs good for palliative care of cancers?

Answer 5

very food painkiller and possible anti-tumour effect (carcinoma)

Question 6

what are the contraindications of NSAIDs?

Answer 6

don’t use with corticosteroids
don’t use with GI/kidney issues or dehydration

Question 7

what is an example of a prostaglandin receptor antagonist that can be used for pain management?

Answer 7

grapiprant

Question 8

what is the mode of action of tramadol?

Answer 8

weak mu agonist

Question 9

what are some side effects of tramadol?

Answer 9

dysphagia, sedation, nausea

Question 10

is tramadol more efficacious in dogs or cats?

Answer 10

good evidence in cats (poor palatability)
little evidence for use in dogs

Question 11

what is the mechanisms of pain caused by osteosarcomas?

Answer 11

inflammation due to neoplastic osteoblasts
bone destruction due to osteoclasts

Question 12

how can radiation therapy help with pain management in osteosarcoma cases?

Answer 12

causes cell death of neoplastic osteoblasts and resorbing osteoclasts (minimal side effects because it is localised treatment)

Question 13

how can bisphosphonate be used in palliative care of osteosarcoma?

Answer 13

it induces osteoclasts apoptosis which limits bone resorption (can be used for multiple cancers associated with osteolysis)

Question 14

what sort of pain can bisphosphonates aid treatment of?

Answer 14

pain associated with osteolysis as it induces apoptosis of osteoclasts to limit the bone resorption

Question 15

what are some symptom relief palliative care treatments for neoplasias?

Answer 15

amputation
surgical excision of masses
stenting (urethra, trachea…)
cystotomy tubes (for urethral obstructions)

Question 16

why is nutrition important in cancer cases?

Answer 16

anorexia is common due to cancer/treatment
weight loss is negative prognostic factor
associated with quality of life

Question 17

what is the difference between anorexia and cachexia?

Answer 17

anorexia - not eating leading to decreased fat
cachexia - muscle wasting

Question 18

why does anorexia occur in cancer patients?

Answer 18

oral/abdominal pain associated with neoplasia
chemotherapy side effects (decreased appetite…)
cytokine release (anorexigen activity)

Question 19

why does cachexia occur with cancer patients?

Answer 19

cytokine release triggering lipolysis and proteolysis
cancer triggering insulin resistance
(more common in cats)

Question 20

what medication can be used to manage anorexia associated with cancers?

Answer 20

manage vomiting/nausea - maropitant

Question 21

what feeding techniques can be used to manage anorexia associated with cancer?

Answer 21

diet change (more appetising)
change consistency (softer if painful mouth…)
small frequent meals
warming meals
oesophagostomy tubes

Question 22

what are the negatives of using steroid as treatment for cancers?

Answer 22

weak analgesia
can’t use NSAIDs with them
muscle wasting and other side effects
can prevent diagnosis of some neoplasia (round cell)