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Palliative Care + Oncology > Symptom control 1 > Flashcards

Symptom control 1 Flashcards

Agitation / Secretions / Hiccups / N+V / Nutrition

1
Q

What should you look for if confusion [6]

A 
Infection
Dehydration 
Retention
Medication
Hypercalcaemia
Electrolyte imbalance
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2
Q

Where are sources of information for reasons for confusion

A 
Nurse
Relative
NEWS
Drug cardex
Blood results 
4AT
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3
Q

What examination can you do in a palliative patient presenting with confusion [4]

A

Chest
Abdo
Neuro
PEARL

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4
Q

What can you use if specific Rx fails

A

Haloperidol = 1st line

Chloropromazine

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5
Q

What is used in terminal phase of agitation / restless

A

Midazolam

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6
Q

What is licensed for intractable hiccups

A

Chloropromazine

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7
Q

What is also used for intractable hiccups [3]

A

Haloperidol
Gabapentin
Dexamthasone - hepatic

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8
Q

What are common in final days of life

A

Secretions

More troubling for family

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9
Q

What is conservative Rx for secretions

A

Avoid overload - stop IV or SC fluid

Educate family that patient is not troubled

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10
Q

What is medical management of secretions?
MOA?
SE profile [2]

A

Hyoscine hydrobromide
Centrally acting anti-muscarinic also used in motion sickness

SE:

  • central anticholinergic syndrome (excitement, ataxia, hallucinations, behavioural abnormalities, drowsiness)
  • anti-muscarinic side effects
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11
Q

When is hycosine butyl bromide indicated? [2]

What are contraindications of hycosine? [3]

A

Bowel colic
Excessive respiratory secretions

Contraindications:

  • GI obstruction,
  • myasthenia gravis
  • BPH, urinary retention
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12
Q

What can cause nausea in palliative care [7]

A 
Metabolic
Drugs
Infection
Intra-cranial
Abdominal 
Psychological 
SE chemo therapy
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13
Q

What are metabolic causes of nausea [3]

A

Uraemia
Hyperclacaemia
Circulating Ig

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14
Q

What drugs cause nausea [7]

A 
Opioids 
NSAID
Chemo
Abx
SSRI 
Iron 
Digoxin
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15
Q

What abdominal causes of nausea [3]

A

Gastric outlet obstruction
Constipation
Mass

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16
Q

What is useful if intra-cranial lesion causing N+V [2]

A

Dexamethasone

Haloperidol

17
Q

What are RF of chemo related N+V [4]

A

Anxiety
<50
Concurrent use of opioids

18
Q

What is used if low risk of N+V Sx in chemo

A

Metoclopramide

19
Q

What is added if doesn’t work or if high risk [2]

A

5HT3 receptor antagonist - ondansetron

Dexamethasone

20
Q

What are used as anti-emetics [5] (class of drugs)

A 
Neurotransmitter blockers
Dopamine antagonist
Anti-histamine
Anti-cholinergic
5HT3 antagonist
21
Q

What are dopamine antagonist and what are they useful for [3]

A

Haloperidol - N+V in palliative care
Metoclopramide - gut peristalsis
Levomepromazine - sedative

22
Q

What anti-cholinergic

A

Hyoscine hydrobromide

23
Q

Eg of 5HT3 antagonist

What is it useful for [4]

A 
Ondanstron 
Post op use
Chemo
Gastroenteritis
Vestibular causes of nausea
24
Q

What is downside of 5HT3 antagonist [2]

A

Very constipation inducing

Expensive

25
Q

What happens to calcium in a sick person [2]

A

Albumin is low

Ca levels may be normal but ionised Ca will be too high

26
Q

What are consequences of malnutrition [6]

A 
Impaired immune
Poor wound healing
Muscle wasting and weakness
Impaired organ function
Altered drug
Poor response to Rx
27
Q

What is cancer cachexia [2]

A

Unintential body and lean tissue wasting

Metabolic abnormality results in increased energy, fat and oxidation

28
Q

What does it lead too [3]

A

GI disturbance
Anorexia
Undernutriton

29
Q

How do you treat [2]

A

Adequate replacement and supplements
Appetite stimulates
MUST screening on admission and weekly

30
Q

What replacement feed options do you have [6]

A 
Energy and protein dense diet
Food fortification
Oral supplement
NGT
PEG
TPN
31
Q

What stimulates appetite? [3]

A

Megace
Dexamethasone
Alcohol

32
Q

Indications for metoclopromide or domperidone (pro-kinetics) [3]
Contraindications [3]
SE [3]

A

Ind:

  • N&V from clinical toxicity (metoclopramide only)
  • motility disorders
  • migraine

CI:

  • post-GI haemorrhage
  • obstruction, perforation
  • pheochromocytoma

SE:

  • extra-pyramidal symptoms
  • hyperprolactinaemia
  • GI upset
33
Q 
Haloperidol
Class of drug
Indications [3]
Contraindication [2]
SE [3]
Interactions [3]
A

D2 receptor antagonist (plus anticholinergic and alpha adrenergic effects)

Ind:

  • N&V due to clinical toxicity in palliative care
  • anti-psychotic
  • hiccups in palliative care

CI: coma, pheochromocytoma

SE:

  • extrapyramidal symptoms, hyperprolactinaemia
  • anti-cholinergic effects (constipation, urinary retention, dry mouth)

Interactions:
- potentiate effects of alcohol and sedatives, beta blockers

34
Q

Ondansetron
Contraindication [1]
SE [3]
Interactions [3]

A

CI: congenital long QT syndrome

SE:

  • constipation, headache, abdo pain, drowsiness
  • QT prolongation, arrhythmia
  • injection site reaction

Interactions:
- anti-arrhythmic, beta blockers, avoid in any drugs that cause QT prolongation

35
Q 
Cyclizine
MOA
Indications [2]
SE [2]
Interactions [2]
A

Anti-histamine (blocks histamine receptor blockers) in vestibular system and VC
Ind: vestibular causes, ICP
SE: drowsiness, anticholinergic effects
Interactions: alcohol, BDZ

36
Q

Levomepromazine
MOA
Indications [2]
Contraindications [3]

A

Phenothiazine (dopamine, 5HT2, alpha 1 adrenergic, histamine and ACh antagonist) so broad spectrum anti-emetic

Ind:

  • N&V post-op
  • refractory or multifactorial N&V in palliative care

CI: coma, pregnancy, breastfeeding

37
Q

Levomepromazine SE [6]
Interactions [1]
Education [1]

A

SE:

  • hypotension
  • neuroleptic malignant syndrome
  • GI SE, respiratory depression
  • extra-pyramidal SEs
  • anti-muscarinic effects
  • prolonged QT interval
  • Interactions: avoid in any drugs that cause QT prolongation or drugs which have similar effects
  • Education: alcohol may potentiate effects

Palliative Care + Oncology (5 decks)

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