Symptom control 2 Flashcards
Clinical toxicity
Ax [4]
Presentation [2]
CTZ chemical stimulation by:
- Drugs
- Carcinomatosis or chronic infection
- Metabolic
Presentation:
- persistent and severe nausea
- little relief from vomiting or retching
Clinical toxicity
Mx [4]
Rx if chemotherapy or RT related?
- Manage metabolic imbalance
- DA antagonist: metoclopramide
- Haloperidol
- Chemotherapy or RT related: ondansetron
Drugs that can cause clinical toxicity [7]
- cytotoxics
- opioids, syrupy liquids
- antidepressants
- abx
- anticonvulsants
- digoxin and cardiac drugs
- alcohol
Metabolic causes of clinical toxicity [6]
- uraemia
- hypercalcaemia
- hyponatraemia
- ketoacidosis, infection
- Addison’s
- circulating toxins
Motility disorders
Another name
Ax [5]
aka Squashed stomach syndrome Ax: gastric stasis (functional) • Autonomic neuropathy: paraneoplastic • Drugs: opioid, anticholinergic • Metabolic: hypercalcaemia • Colic caused by prokinetic agent
Motility disorders
Presentation [4]
Management [3]
- intermittent large volume vomit with temporary relief of symptoms
- early satiation
- reflux, hiccup
- little nausea prior to vomit
Management
- mx of any underlying cause (drainage and diuretics for ascites)
1. Prokinetic: e.g. METACLOPRAMIDE or DOMPERIDONE (elderly or high risk extra-pyramidal SE) -
DO NOT combine pro-kinetics with anti-cholinergic e.g. CYCLIZINE, HYOSCINE*
2. Steroids can also be tried
Intracranial disorders etiology [2]
Presentation [4]
Ax:
- raised ICP by skull base tumour or space occupying lesion
- vestibular nerve or inner ear stimulation by ototoxicity or middle ear problems
Presentation:
- Headache
- Altered GCS
- Vertigo
- Motion sickness
Intracranial disorders mx:
- Increased ICP [2]
- Movement related nausea [3]
- Increased ICP: CYCLIZINE, DEXAMETHASONE
* Movement related nausea: CYCLYZINE, HYOSCINE HYDROBROMIDE, CINNARIZINE
Oropharyngeal irritation
Presentation
Mx
Sy/Si: worse on eating, exacerbated by food or smells, reflux symptoms, retching assoc. w/ productive cough
Mx: mx of reflux and infection etc, CYCLIZINE or HYOSCINE HYDROBROMIDE
Oropharyngeal irritation
Ax [10]
Cranial nerve irritation (vagus and glossopharyngeal) by
• Tumour
• Sputum or secretion stimulating gag reflex
• Acid reflex
• Toxins
• Inflammation
• Infection: candida, HSV
• Foreign body
• Smells from wounds, stomas, food and other sources
• Poor oral hygiene
Constipation causes in palliative patients [6]
Medication Secondary effects of illness, Concurrent disease Tumour in or compressing the bowel wall Nerve damage Hypercalcemia
What medication can cause constipation [5]
What secondary effects of illness can cause infection? [4]
Medication:
- opioids, antacids, diuretics, iron, ondansetron
Secondary effects of illness:
- dehydration, immobility, poor diet, anorexia
Management of constipation [3]
Laxatives - senna +/- docusate or macrogol
Rectal treatments:
- for soft/hard loading - bisacodyl suppository
- very hard loading: arachis oil enema overnight then phosphate enema
Laxative types [4]
Stimulant
Bulk forming
Softeners
Osmotic laxatives
Stimulant laxatives
Eg [4]
MOA
Indication
- Senna, bisacodyl, docusate, glycerol
- MOA: increases volume of bowel electrolytes drawing water from bowel into mucosa
- stimulates peristalsis
- Ind: constipation, fecal impaction