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CCC > Treatment for Palliative patients > Flashcards

Treatment for Palliative patients Flashcards

1
Q

How can bone mets be treated?

A

Palliative radiotherapy

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2
Q

What is palliative chemo used for?

A

Tumour masses compressing viscera or nerves

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3
Q

When can palliative surgery be used?

A

Intramedullary nail for pain from a femoral met

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4
Q

When can anaesthetic & neurosurgical interventions be used in palliative cancer?

A

Paravertebral nerve block

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5
Q

How can vomiting caused by gastric stasis/irritation be treated?

A

Metoclopramide 10-20mg PO
30mins before meal
30-60mg SC/24hrs
Consider PPI

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6
Q

How can vomiting caused by toxins be treated?

A

Haloperidol 1.5-5mg PO/SC
Levomepromazine
Cyclizine

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7
Q

How can vomiting caused by cerebral causes be treated?

A

Dexamethasone 8-16mg OD (po) &
Cyclizine 50mg TDS (po/sc)
or 150mg sc/24hrs
Lorazepam

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8
Q

How can vomiting caused by anxiety, anticipation be treated?

A

Benzos, CBT, complementary therapies

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9
Q

How can vomiting of unknown cause be treated?

A

Levomepromazine 6.25-12.5mg po/sc

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10
Q

How is oral thrush treated?

A

Systemic Antifungals
Fluconazole 50mg OD/7days
Topical agents
Nystatin 1ml QDS/7days

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11
Q

How is anorexia treated?

A

Dexamethasone 4mg OD to inc appetite but wears off after 2-3weeks
Megestrol Acetate 160mg OD effective for longer but can cause fluid retention

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12
Q

What type of laxatives are rarely appropriate for palliative patients

A

Bulk forming agents

Fybogel

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13
Q

What are the groups of laxatives and give examples of each

A

-Bulk forming: Fybogel
-Stool softners: Lactulose, Docusate capsules
-Stimulants: Senna, Dantron, Bisacodyl
-Mixed: Co-Danthrusate, Movicol
All come in 125ml sachet

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14
Q

What are the side effects of lactulose?

A

Significant bloating

Flatulence

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15
Q

For opioid induced constipation which are the best laxatives to use?

A

Movicol
Co-Danthramer
Co-Danthrusate

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16
Q

When should stimulant laxatives be avoided?

A

Patient with colic

Also avoid pro kinetic drugs (Metoclopramide)

17
Q

What medications can be used in bowel obstruction in palliative patients?

A 
Surgical intervention dependant on status
Meds given by continuous sc infusion
Antiemetics
Analgesia
Antispasmodics (Hyoscine Butylbromide)
Other: Dex, Octreotide
18
Q

Generally, how are the following treated:

  • Asthma
  • PO
  • PE
  • Exacerbation of COPD
  • Pneumonia
  • SVCO
  • Bronchial Obstruction by tumour
A
  • A: Bronchodilators
  • PO: Diuretics, diamorphine
  • PE: Anticoag (Tinz)
  • COPD: Abx, bronchodilators
  • Pneu: Abx, physio
  • SVCO: Dex, urgent stenting
  • Obstruction: Dex, ?stents/laser
19
Q

Generally, how are the following treated:

  • Congestive HF
  • Anaemia
  • Pleural effusion
  • Ascites
  • Lymphangitis carcinomatosis
A
  • HF: Diuretics, ACEi, Digoxin
  • Anaemia: Transfusion
  • PE: ?Pleural aspiration/pleurodesis
  • Asc: Paracentesis
  • LC: Trial Dex
20
Q

What treatment can be give for anxiety w/SOB or panic attacks?

A

Lorazepam 0.5mg-1mg sub-lingual

Midazolam 2.5mg-5mg sc

21
Q

What medications should be stopped in patients who cannot swallow (related to end of life)?

A 
Vitamins/iron
Hormones
Anticoag
Corticosteroids
Abx
Antidepressants
CV drugs
Anticonvulsants used for pain
22
Q

In terminal illness what anticipatory meds should be prescribed?

A

Analgesics (Diamorphine)
Antiemetics (Levomepromazine/ Haloperidol)
Antisecretories (Hyoscine B)
Anxiolytics (Midazolam)

23
Q

How can terminal restlessness be treated?

A

Midazolam sc
stat: 2.5-5mg
Infusion: 10mg/24hrs

24
Q

How can ‘death rattle’ be treated?

A 
Hyoscine Butylbromide (Buscopan)
Hyoscine Hydrobromide
25
Q

What medications can be put into a syringe driver?

A 
Diamorphine/ morphine sulphate
Cyclizine
Haloperidol
Metoclopramide
Levomepromazine
Hyoscine B/H
Midazolam
26
Q

What are the indications for a syringe driver in terminal care?

A
  • Inability to swallow (reduced consciousness)
  • Persistent N&V
  • Intestinal obstruction
  • Dysphagia
  • Malabsorption of drugs
  • Inadequate pain control is NOT an indicator
27
Q

What are possible sites for a syringe driver? Where is contraindicated?

A

Possible: Chest, abdo, upper arm, thigh
CI: broken skin, oedematous areas

28
Q

Which drugs are unsuitable for Sc administration?

A

Too irritant
Diazepam
Chlorpromazine
Prochlorperazine

CCC (21 decks)

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