Supportive Care (Part 2) Flashcards

1
Q

Causes of nausea

A
  1. Disease-related: tumour obstruction, intestinal obstruction, gastric stasis, raised ICP from brain metastases
  2. Biochemical: chemical/toxic causes (hypercalcemia, uraemia, drugs)
  3. Treatment-related: radiotherapy, chemotherapy
  4. Supportive medications: opioids
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2
Q

Before prescribing for established nausea/vomiting:

A
  1. History - a separate history for both nausea and vomiting
  2. exclude regurgitation
  3. check for other concurrent symptoms
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3
Q

Nausea and vomiting - management

A
  1. Metoclopramide (first-line, is a prokinetic)
    2, Haloperidol (dopamine agonist, another option)
  2. Ondansetron, mirtazapine, olanzapine - not first line
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4
Q

Nausea and vomiting - non-pharmacological advice

A
  1. Breaking up into smaller meals/day rather than 3 large meals
  2. Rinse mouth before eating with 1 teaspoon of soda/sodium bicarbonate powder to remove bad tastes
  3. Avoid hot spicy foods / foods that are very sweet, fatty or greasy
  4. Find a peaceful eating place / relaxed atmosphere
  5. Certain candies like lemon drops, peppermints can relieve nausea
  6. Drink clear liquids as much as possible to relieve diarrhoea
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5
Q

Dopamine receptor antagonists

  1. Types of drugs
  2. Causes
A
  1. Metoclopramide, haloperidol

2. Clinical toxicity, metabolic/biochemical upset

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6
Q

Drugs that cause motility disorders

A

Prokinetics - metoclopramide, domperidone

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7
Q

Drugs that cause intracranial disorders , as well as oral or pharyngeal irritation

A

Anticholinergic or antihistamine (hyoscine, prochlorperazine

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8
Q

Management of depression

A
  • set aside time for patient to clarify concerns and express his feelings
  • explain their disorder to them in terms of illness and situation, as well as supportive mechanism
  • recommend CBT, relaxation and creative therapies with psychological benefits etc.
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9
Q

Assessment of depression (palliative care)

A

PHQ-9 tool

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10
Q

Antidepressant common treatment medications

A

SSRI, mirtazapine

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11
Q

Cause of xerostomia

A
  • radiation therapy to the neck and head area
  • surgery of the neck and head involving the removal of salivary glands
  • certain chemotherapeutic agents
  • oral infections
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12
Q

management of xerostomia

A
  1. frequent oral rinses and sips of water or juice (papaya).
  2. mouth care before or after meals. Avoid dry, sticky foods and choose soft, moist foods instead.
  3. Increase intake of fluids during meals (avoid alcohol and carbonated drinks)
  4. Suck on hard sugarless candies or chew on surgarless gum to lubricate the oral cavity
  5. Apply lip moisturiser (pilocarpine) to prevent drying and chapping of lips.
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13
Q

Characteristics of delirium, as well as types of delirium

A
  • acutely confused, agitated and restless
  • types:
    1. hyperactive: increased arousal and agitation
    2. hypoactive: quiet, withdrawn and inactive
    3. mixed pattern
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14
Q

Assessment of delirium

A
  • MMSE, CAM
  • check for infection (urine infection in the elderly)
  • assess for opioid toxicity (reduce opioid dose by a third, consider switching if delirium persists)
  • check for sensory impairment
  • check for constipation, urinary retention or catheter problems.
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15
Q

Pharmacological management

A

First choice: haloperidol, dose once orally or subcutaneously and repeat 2 hours again if necessary.
» maintenance dose may be needed.

Second choice: benzodiazepines
» do not improve cognition but help with anxiety.
» PO or SLT lorazepam
» SC midazolam 1-2 hourly, or PO diazepam 8-12 hourly

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16
Q

pruritis management for:

  1. Cholestasis
  2. Uremia
  3. Lymphoma
  4. Opioid-induced pruritus
  5. Paraneoplastic
A
  1. rifampicin, sertraline, cholestyramine (once daily)
  2. gabapentin (administer naltrexone in the event of renal impairment, or dose adjust) (once daily)
  3. prednisolone (three times daily)
  4. chlorpheniramine (use three times daily if there’s benefit)
  5. paroxetine (once daily)
17
Q

pruritus non-pharmacological management

A
  • use emollient frequently and liberally, as moisturiser
  • add emollient to bath water, use emollient as soap substitute
  • apply topical corticosteroids once daily for 2-3 days if the area is infected but not inflamed, review after 7 days.
  • review benefit of lidocaine patches after 3 days
18
Q

pruritus practice points

A
  • avoid topical antihistamines: may cause contact dermatitis
  • avoid vasodilators such as caffeine, alcohol, spices and hot water.
  • ointments take longer to be absorbed into the skin, may not be as well tolerated.