Palliative Symptoms Management

Question 1

Common Symptoms in Palliative Care

Answer 1

• Fatigue
  
  • Pruritis
  • Delirium
  • Respiratory
    
    • Cough
    • Dyspnoea
    • Hiccoughs
    • Secretions
  • GIT
    
    • Reduced appetite
    • Constipation
    • Diarrhoea
    • Vomiting
  • Pain (see pain notes)

Question 2

Palliative Cough Management

Answer 2

Opiates

Question 3

Palliative Dyspnoea Management

Answer 3

• Non-pharmacological
  * Positioning
  * Environment
  * Relaxation
  • Pharmacological
    
    • Oxygen
    • BZD
    • Opioids

Question 4

Palliative Hiccoughs Management

Answer 4

• Causes (reduce/cessate medication)
  * Dexamethasone
  • Pharmacological treatment
    
    • Metoclopramide
    • Nifedipine or baclofen
    • Chlorpromazine

Question 5

Palliative Respiratory Secretions Management

Answer 5

• Anticholinergics
  * Hyoscine hydrobromide
  * Atropine
  * Glycopyrronium

Question 6

Palliative Reduced Appetite Management

Answer 6

• Metoclopramide

* Dexamethasone

Question 7

Palliative Constipation Causes

Answer 7

• Causes
  * Drugs
  * Immobility
  * Low fibre
  * Dehydration
  * Colorectal causes
  * Electrolyte disturbances

Question 8

Palliative Constipation Management

Answer 8

• Management
  * Soft rectal faeces (one of)
  * Bisacodyl
  * Senna
  * Hard rectal faeces (add one of)
  * Macrogol
  * Sodium phosphate
  * Possibly manually disimpact

Question 9

Palliative Vomiting Causes

Answer 9

• Causes
  * Obstruction
  * Gastric
  * Central
  * Chemical

Question 10

Palliative Vomiting Management

Answer 10

• Targets the Chemoreceptor Trigger Zone (CTZ)
  * Antipsychotics
  * Chlorpromazine
  * Prokinetics
  * Metoclopramide
  * Domperidone
  * 5-HT3 antagonists
  * Ondansetron
  • Targets the Vomiting Centre (VC)
    
    • Antimuscarinics
      
      • Hyoscine
      • Hydrobromide
    • Antihistamines
      
      • Cyclizine