Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Palliative Care + Oncology > Symptom control 2 > Flashcards

Symptom control 2 Flashcards

1
Q

Clinical toxicity
Ax [4]
Presentation [2]

A

CTZ chemical stimulation by:

  • Drugs
  • Carcinomatosis or chronic infection
  • Metabolic

Presentation:

  • persistent and severe nausea
  • little relief from vomiting or retching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical toxicity
Mx [4]
Rx if chemotherapy or RT related?

A
  • Manage metabolic imbalance
  • DA antagonist: metoclopramide
  • Haloperidol
  • Chemotherapy or RT related: ondansetron
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Drugs that can cause clinical toxicity [7]

A
  • cytotoxics
  • opioids, syrupy liquids
  • antidepressants
  • abx
  • anticonvulsants
  • digoxin and cardiac drugs
  • alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Metabolic causes of clinical toxicity [6]

A
  • uraemia
  • hypercalcaemia
  • hyponatraemia
  • ketoacidosis, infection
  • Addison’s
  • circulating toxins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Motility disorders
Another name
Ax [5]

A 
aka Squashed stomach syndrome
Ax: gastric stasis (functional)
•	Autonomic neuropathy: paraneoplastic 
•	Drugs: opioid, anticholinergic 
•	Metabolic: hypercalcaemia 
•	Colic caused by prokinetic agent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Motility disorders
Presentation [4]
Management [3]

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Intracranial disorders etiology [2]

Presentation [4]

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Intracranial disorders mx:

  • Increased ICP [2]
  • Movement related nausea [3]
A
  • Increased ICP: CYCLIZINE, DEXAMETHASONE

* Movement related nausea: CYCLYZINE, HYOSCINE HYDROBROMIDE, CINNARIZINE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Oropharyngeal irritation
Presentation
Mx

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Oropharyngeal irritation

Ax [10]

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Constipation causes in palliative patients [6]

A 
Medication
Secondary effects of illness, Concurrent disease
Tumour in or compressing the bowel wall
Nerve damage
Hypercalcemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What medication can cause constipation [5]

What secondary effects of illness can cause infection? [4]

A

Medication:
- opioids, antacids, diuretics, iron, ondansetron

Secondary effects of illness:
- dehydration, immobility, poor diet, anorexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of constipation [3]

A

Laxatives - senna +/- docusate or macrogol

Rectal treatments:

  1. for soft/hard loading - bisacodyl suppository
  2. very hard loading: arachis oil enema overnight then phosphate enema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Laxative types [4]

A

Stimulant
Bulk forming
Softeners
Osmotic laxatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stimulant laxatives
Eg [4]
MOA
Indication

A
  • Senna, bisacodyl, docusate, glycerol
  • MOA: increases volume of bowel electrolytes drawing water from bowel into mucosa
  • stimulates peristalsis
  • Ind: constipation, fecal impaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Stimulant laxatives
CI [3]
SE [2]
Education

A

CI: GI obstruction, perforation, heart failure

SE:

  • N&V, abdo pain and discomfort, diarrhoea
  • clinically irrelevant red/brown urine discolouration (Senna)

Education: take a few hours to work

17
Q

Bulk forming laxatives
Eg [2]
MOA [3]
Indication [4]

A

Ispagula hulk, normacol

MOA:

  • contain indigestible polysaccharides
  • which increase faecal mass
  • stimulate stretch receptors in the bowel mucosa increasing peristalsis and defecation

Indication:
- Constipation especially IBD, diverticulitis, colostomies, ileostomies

18
Q

Bulk forming laxatives
CI [3]
SE [4]
Education

A

CI:

  • faecal loading
  • intestinal obstruction
  • reduced gut motility
  • so UNSUITABLE IN PALLIATIVE PATIENTS

SE:

  • flatulence
  • abdo distension
  • intestinal obstruction, GI impaction

Education:
- unlikely to work if already have good fluid intake and high fibre diet

19
Q 
Softener laxatives
Eg [2]
MOA
Indication [2]
Education [3]
A

Eg: decussate sodium, liquid paraffin
MOA: Soften stool and act as a lubricant
• Ind: constipation, faecal impaction
• Education: liquid paraffin not before bed, docusate takes 1-2d to work orally but only 20 mins rectally

20
Q

Osmotic laxatives
Eg [2]
MOA [3]

A

Eg: lactulose, laxido
MOA:
- Composed of sugar that is not digested or absorbed
- so maintains water in intestinal lumen and holds it there
- to provoke peristalsis and maintain faecal bulk

21
Q

Osmotic laxatives
CI [3]
SE [4]
iNTERACTIONS [1]

A
  • CI: obstruction/perforation, paralytic ileus (laxido), galactosaemia (lactulose)
  • SE: abdo discomfort, cramps, flatulence, N&V, electrolyte imbalance
  • Interactions: may increase effects of warfarin
22
Q

Dyspnoea in palliative patient

Differentials [8]

A
  • Recurrent PTX or pleural effusion
  • Pre-exising lung condition
  • SVC obstruction, lung mets lymphangitis carcinomatosis, bronchial obstruction
  • Increasing anxiety
  • Anaemia
  • Pericardial effusion
  • Diaphragmatic splinting (ascites)
  • Muscle weakness (cachexia, paraneoplastic syndrome)
23
Q

Management of dyspnoea in palliative care [3]

Rx [5]

A
  • Underlying cause
  • Non pharmacological
  • Pharmacological
    > Opioids
    > CCS
    > BDZ
    > O2 if SpO2 <92%
    > Nebulised NaCl
24
Q

Non-pharmacological methods of dyspnoea mx [4]

A
  • self-management plan
  • smoke free environment, positioning
  • controlled breathing
  • planning and pacing activities

Palliative Care + Oncology (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions