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Cancer care > N+V, constipation and breathlessness > Flashcards

N+V, constipation and breathlessness Flashcards

1
Q

Causes of N+V

A 
Infection
Hypercalcaemia
Opioids
Renal/hepatic failure
Gastric stasis
Constipation 
Raised ICP
Anxiety
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2
Q

What transmitters act on the chemoreceptor trigger zone in the postrema

A

NK1
Dopamine
Serotonin

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3
Q

What transmitters act on the vomiting centre in the postrema

A

NK1
ACh
Histamine
Serotonin

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4
Q

What transmitters act on the VIII nucleus

A

ACh

Histamine

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5
Q

What does haloperidol act on

A

Chemoreceptor trigger zone (very inhibitory)

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6
Q

What does metoclopramide act on

A

Chemoreceptor trigger zone

Vagus afferents

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7
Q

What does domperidone act on

A

Chemoreceptor trigger zone

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8
Q

What does cyclizine act on

A

Vomiting centre

VIII nucleus

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9
Q

What does ondansetron act on

A

Vagus afferents (very inhibitory)

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10
Q

Choice of anti-emetic for chemical causes of N+V

A

Haloperidol

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11
Q

Choice of anti-emetic for gastric stasis causes of N+V

A

Metoclopramide

Domperidone

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12
Q

Choice of anti-emetic for bowel obstruction causes of N+V

A

Cyclizine

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13
Q

Choice of anti-emetic for raised ICP causes of N+V

A

Cyclizine

Dexamethasone

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14
Q

Choice of anti-emetic for post-op and post-radiotherapy causes of N+V

A

Ondansetron

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15
Q

What is aprepitant and how is it used

A

NK1 antagonist

Regularly given SC for chemo induced N+V

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16
Q

Management of malignant BO

A 
Stent if single level of obstruction
Surgery if suitable
Venting gastrostomy 
NG tube
Cyclizine and octreotide (somatostatin) to slow gastric emptying 
Analgesia (opioids)
Anticholingeric to reduce intestinal secretions and slow gut motility (glycopyrronium preferred or hyoscine hydrobromide)
Corticosteroid + PPI
17
Q

Classes of laxatives and examples

A

Stimulant - senna, sodium picosulphate
Softener - docusate, glycerin
Osmotic - lactulose, movicol, laxido

18
Q

MoA of stimulant laxative

A

Reduce bowel transmit time

19
Q

MoA of softener laxative

A

Increase water penetration into stool

20
Q

MoA of osmotic laxative

A

Holds water in the bowel lumen

21
Q

Broad causes of breathlessness (2)

A

Increased respiratory drive

Reduced physiological capacity to breathe

22
Q

Treatable causes of breathlessness

A 
Anaemia
COPD
PE
CCF
Pleural effusion
RTI
SVCO
Anxiety
23
Q

Management of intractable breathlessness

A 
Sit up
Fan/open window
Oxygen only if hypoxia
Morphine PRN
Lorazepam or midazolam PRN
24
Q

What 2 antiemetics shouldn’t be prescribed together and why

A

Cyclizine (slows gastric emptying)

Metoclopramide (speeds up gastric emptying)

Cancer care (12 decks)

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