Symptomatic treatment Flashcards
Symptoms of cancer
Breathlessness
Nausea and vomiting
Constipation
Causes of cancer related breathlessness (9)
Anaemia PE Congestive cardiac failure COPD Respiratory tract infection - pneumonia Pleural effusion Pericardial effusion SVCO Anxiety
Investigations for breathlessness
Anaemia - Bloods
PE - CTPA
Congestive cardiac failure - CXR, BNP
COPD - Spirometry
Pneumonia - Bloods, culture, CXR
Pleural effusion - CXR
Pericardial effusion - CXR, CT
SVCO - CXR
Anxiety - Bloods
Treatment for breathlessness
Anaemia - treat cause e.g. iron supplements or transfusion
PE - Enoxaparin (LMWH or DOAC)
Congestive cardiac failure - Diuretics, ACEi
COPD - bronchodilators
Pneumonia - abx
Pleural effusion - aspiration, chest drain (pluerodesis)
Pericardial effusion - paracentesis, corticosteroids
SVCO - Stent, radiotherapy or steroids
Anxiety - CBT, benzodiazepines, SSRIs
General management of breathlessness
Consider oramorph 1 - 2mg PRN
If anxiety - sublingual lorazepam
Common causes of nausea and vomiting
Infection
- UTI
- pneumonia,
- gastro-enteritis
- thrush
Metabolic
- renal impairment
- hepatic impairment
- hyponatraemia
- hypercalcaemia
- sepsis
- tumour toxins
- stopping steroids quickly
Drug related
- opiods
- abx
- NSAIDs
- diuretics
- digoxin
- SSRIs
- chemo
Gastric stasis
- pyloric tumours
- ascites
- hepatomegaly
- opioids
- anticholinergics
- DKA- pancreatic cancer
GI disturbance
- constipation
- gastritis
- ulceration
- obstruction
Organ damage
- distention
- obstruction
- radiotherapy
Neurological
- raised ICP
- motion sickness
- meningeal disease
Psychological - anxiety/ fear
Raised ICP symptoms
Headaches
Confusion
Visual disturbances
Worse in the morning
Symptoms of hypercalcaemia
Headaches Constipation Bone pain Nausea Dark urine
Receptors in the chemo trigger zone
D2 - Dopamine receptors
NK1 - natural killer receptors
5HT3 - Serotonin receptors
Receptors in the vomiting centre
Achm - Acetylcholine receptors
H1 - histamine receptors
5HT2 - Serotonin receptors
Receptors in the VIII nucleus
Achm - Acetylcholine receptors
H1 - histamine receptors
What triggers the chemo trigger zone
Toxins in blood
What triggers the vomiting centre
Higher centres - anxiety/ fear/ pain
Autonomic afferents
Medication for nausea and receptors
Haloperidol - D2
Metoclopramide - D2, 5HT3
Domperidone - D2
Cyclizine - Ach, H1
Levomepromazine - D2, 5HT2, Ach, H1
Ondansetron - 5HT3
Hyoscine hydrobromide - Ach
Prochlorperazine - D2, Ach, H1
Aprepitant - NK1
Feature of prochlorperazine
Weak antiemetic
Used in GP
Which anti-emetics cause sedation
Levomepromazine
Hyoscine hydrobromide
Which antiemetic is used for chemical causes of nausea
Haloperidol or metoclopramide if gastric stasis
Features of chemical nausea
Persistent Often severe Unrelieved by vomiting aggravated by the sight and smell of food Drowsiness and confusion
Which antiemetic is used for gastric stasis causes of nausea
Metoclopramide
Domperidone
Features of gastric stasis nausea
Fullness and regurgitation
Reduced appetite
Large volume of vomit
Vomiting relieves nausea
Epigastric discomfort
Hiccups
Which antiemetic is used for functional causes of nausea (bowel obstruction)
Cyclizine
Features of functional nausea due to bowel obstruction
High obstruction - regurgitation, forceful vomiting of undigested food
Low: colicky pain, feculent vomit, visible peristalsis
Which antiemetic is used for raised ICP intracerebral causes of nausea
Cyclizine and dexamethasone to reduce cerebral oedema
Features of nausea due to raised ICP intracerebral
Nausea worse in the morning
Projectile vomiting
Worse with head movements
Headache
