Symptom Control Flashcards
Compare nociceptive vs neuropathic pain
nociceptive: functioning nervous system. The pain is localised
neuropathic: dysfunctional nervous system. The pain is generally tingling, it travels and it fluctuates
Describe the WHO pain ladder
- paracetamol, NSAIDs
- codeine, tramadol, dihydrocodeine
- morphine, diamorphine, oxycodone, fentanyl
What are some side effects of opioids?
constipation drowsiness dry mouth N&V respiratory depression
What analgesia is best to use in CKD?
Mild renal impairment: oxycodone
Severe renal impairment: fentanyl and buprenorphine
When would you consider up titrating a persons opioid?
> 3 PRN needed a day
How is someone’s new up titrated dose of morphine calculated?
BD dose + PRN doses used = TDD
New BD = TDD/2
New PRN = TDD/6
What is a typical starting regime for someone new to opioids?
15mg BD zomorph (modified release)
5mg PRN oramorph (immediate release)
Compare the side effect profile of oxycodone and morphine
oxycodone is more constipating however leads to less nausea and drowsiness and pruritis
What are the causes of vomiting in a cancer patient?
gastric dysmotility opioid and chemotherapy induced electrolyte disturbances - uraemia - hypercalcaemia - hyponatraemia anxiety induced RICP
How is chemotherapy induced N&V managed?
Ondansetron
How is metabolic derangement induced N&V managed?
haloperidol or levomepromazine
How is N&V due to reduced gastric motility managed?
Metoclopramide
How is N&V due to mechanical bowel obstruction managed?
Cyclizine
How is anxiety induced N&V managed?
Lorazepam
How is RICP in palliative care managed?
Cyclizine + dexamethasone + radiotherapy
What are some causes of breathlessness in palliative care?
anxiety pneumonia PE SVCO rib metastasis
How is breathlessness in palliative care managed?
Open windows and increase air flow Sit the patient up Talk about any anxieties they are having Breathing exercises and physiotherapy Morphine Benzodiazepines Oxygen
What causes hiccups in palliative patients?
Gastric distention
Phrenic nerve involvement
Uraemia
How are intractable hiccups managed?
Chlorpromazine
+/- haloperidol, gabapentin and dexamethasone
What causes constipation in palliative care?
Opioids Weakness to push Dehydration and malnutrition Immobility Hypercalcaemia Spinal cord compression
How is constipation in palliative care managed?
Co-danthramer (stimulant + softener)
Or
Lactulose + Senna
How does end stage lymphoedema present?
Non-pitting oedema
Chronic skin changes
How is lymphoedema managed?
Gradient compression bandaging
How should psychological distress associated with cancer/ palliation be managed?
How should it be managed in the terminal phase of illness?
Non-pharmacologically: breathing exercises, religious support, CBT
Haloperidol or chlorpromazine
Terminal phase: Midazolam
What are the drug options for respiratory secretions? What is the advantage of one vs the other?
Hyoscine hydrobromide: sedating
Hyoscine butylbromide: non-sedating
Can also use glycopyrronium
What are the advantages and disadvantages of using a patch for analgesia?
+ Less constipating
- Analgesia requirements need to be stable to use
- Increased N&V
- Withdrawal symptoms
