Palliative medicine Flashcards
Most common cause of nausea/comiting?
Chemotherapy
Classification of N/V?
Acute: less than 24 hours after chemotherapy. (serotonin)
Delayed: more than 24 hours
RFs for N/V?
Female
young age
motion sickness
COMBINATION chemotherapy
What decreases risk for N/V?
Alcohol consumption
Which antineoplastic agents have HIGH risk of N/V?
Cisplatin
Cyclophosphamide
Dacarbazine
How to treat high risk N/V?
Use several anti-emetic agents at the same time
Management of N/V?
PREVENTION with antiemetics:
- Ondansetron
- metoclopramdie
- dexamethasone
Criteria for febrile neutropenia?
Temp above 38,5
Neutrophils
What is most concerning complication of chemotx?
Febrile neutropenia
When does febrile neutropenia show an even worse prognosis?
When proven bacteremia
What is name of risk score in febrile neutropenia?
MASCC
Which MASCC score shows low risk of complication?
score over 21
Treatment if low risk of febrile neutropenia?
give oral ABs (ciprofloxacin, amoxicillin)
Treatment if high risk of febrile neutropenia?
give broad-spectrum ABs (carbopenems)
How high is mortality if MASCC score is beklow 15?
36 %
Which therapeutic treatment used in febrile neutropenia?
G-SCF (Filgrastim!)
What is filgrastim?
G-CSF, used in febrile neutropenia
how is pain classified?
Nociceptive: somatic and visceral
Neuropathic: central and peripheral
In which cancer is VISCERAL pain commonly seen?
Pancreatic ca!!!!
Tx of allodynia?
Amytryptiline (TCA)
Gabapentin (Neurontin)
+ non-opioids and strong-opioids
Which ca give bone mets?
Lung
Prostate
Breast
Examples of weak opioids?
Tramadol
Codeine
Examples of strong opioids?
Fentanyl
Morphine
What anti-neoplastic tx may cause dyspnea?
Lung resection
Bleomycin
Radiotx
Tx of dyspnea?
Opiods positioning fresh air Benzo/SSRIs Bronchodilator, steroids, ABs
Whish respiratory symptoms is a POOR prognostic factor?
Recurrent pleural effusion!!!
Criteria used in pleural effusion?
Light’s criteria
Tx for cough?
Morphine
Codeine
Dihydrocodeine
What is the cause of death rattle?
Accumulation of airway secretions –> movement of secretions in hypopharynx
What does death rattle predict?
DEATH (STRONG predictor!)
Management of death rattle?
Positioning
ANticholinergics
Fluid restriction