S3_Symptom Management

Question 1

Dyspnea

Answer 1

As for Stridor,
Do recommend the following combinations should the patient presents with the following add-on symptoms

(1) edema —> steroids, dexamethosone to bring down the swelling

(2) breathlessness —> opioids, such as morphine, fentanyl, oxynorm

(3) agitation —-> sedation suchasmidazolam

Add on Anti-cholinergics
- Buscopan to reduce secretions and if patients are unabletoexpectorate

Question 2

N&V

Answer 2

• metoclopramide
• ⁠ondansetron
  Dexamethasone
  Haloperidol
  Prochlorperazine

Question 3

Bristol Stool Chart!

Answer 3

Type 1- hard, small blobs
Type 2- clumps of small blobs together (lumpy sausage)
Type 3- sausage with cracks
Type 4 - normal
Type 5 - soft pieces/ blobs!
(Clear cut edge)
Type 6 - mushy pieces
(Ragged edge)
Type 7 -entirelywatery

Question 4

Constipation Management

Answer 4

Constipation
- exclude spurious diarrhoea

Stimulant agent
Stimulates peristalsis motion
- Senna, ducolax (suppository)

Osmotic agent
Pulls in fluids from the intestines
- lactulose

Bulk forming
-fybogel

Question 5

Diarrhoea

Answer 5

Diarrhoea
1. Loperamide 2-4mg tds (maximum 16mg/day)

2. Hyoscine Butylbromide (Buscopan)
3. Codeine Phosphate

• Avoid Lomotil (Diphenoxylate/ Atropine) in elderly as Atropine can cause delirium.

Question 6

Why Lomotil is avoided for elderly with Diarrhea?

Answer 6

• Lomotil contains both ingredients, (Diphenoxylate/ Atropine), Atropine can cause delirium.

Loperamide (opioid) is the better choice.

Question 7

What are some of the non-pharmacotherapeutic drugs for Diarrhea?

Answer 7

1. Exclude spurious diarrhea
2. Non-milk diet
3. Oral rehydration salt or isotonic drinks
4. Replace electrolytes lost due to hyponatremia or hypokalemia
5. Prevent pressure injury with barrier cream, pressure relief mattresses and regular turning

Question 8

Pharmacotherapeutic management for Delirium

Answer 8

First Line
Haloperidol (drops/tablets) 0.5-1.5mg tds
Risperidone (drops/tablets) 0.5-1.0mg tds
(for patients with Parkinson’s disease or those developed extra-pyramidal side effects with Haloperidol)

Second Line
If patient is still agitated despite the above, consider:
Switching from Haloperidol to oral or sublingual Olanzepine 2.5mg od- tds
Chlorpromazine 12.5-50mg on

Management of the confused and agitated patient
Subcutaneous Haloperidol 1.0-2.5mg stat.
May need subcutaneous Midazolam 1.0-2.5mg p.r.n.,
if patient is very restless and uncooperative.

Question 9

Non-pharmacotherapeutic mgt for Delirium

Answer 9

• Frequent reorientation
• Providing a calm environment that avoids both sensory deprivation and overstimulation
• Using clear verbal instructions
• Providing emotional support
• Avoiding confrontation
• Do not confront delusional beliefs
• Focus on emotions not content
• Promote a normal sleep-wake cycle
• Correct sensory deficits
• Glasses
• Hearing aids
• Minimize physical restraints
• Consider discontinuing or avoiding intravenous or urinary catheters
• Minimize room and staff changes
• Request that family members bring in familiar items and sit with the patient