everySupportivething Flashcards

(44 cards)

1
Q

Symptoms of Constipation

A

Unable move bowels, push harder to move bowels, moving them less often than usual

Faeces small, dry and hard

Significant variation from normal bowel habit

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2
Q

Causes of constipation

A

Biochemical (Hypercalcemia, Hypokalaemia)
Fluid depletion
Medication (Opioids)
Weakness
Disease related (Immobility, tumour invasion)

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3
Q

Complications of constipation

A
Colic/ abdominal discomfort
Overflow diarrhoea
Restlessness/ confusion if severe
Intestinal obstruction
Faecal incontinence
Urinary retention
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4
Q

What are the bulk forming laxatives? State dose

A

Fybogel, Metamucil

1 satchel BD

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5
Q

What are the osmotic laxatives? State dose

A

Phosphate enemas
Forlax,
Lactulose - 10-15ml BD
PEG

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6
Q

What are the stimulant laxatives? State dose

A

Senna - 2-4 tabs daily

Bisacodyl - 5-10 mg ON, up to 20mg daily

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7
Q

If rectum is impacted and stools are hard? WYD?

A

Lubricate with glycerin suppositories OR soften with olive oil enema followed by phosphate enema once softened

Once disimpacted, commence or increase oral stimulant/ softener

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8
Q

If rectum is impacted and stools are soft? WYD?

A

Use a rectal stimulant

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9
Q

If rectum not impacted and not dilated? WYD?

A

Consider additional laxatives, ensure pt is on regular laxatives.

Exclude intestinal obstruction

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10
Q

If rectum not impacted BUT dilated, WYD?

A

Suggest constipation is higher up, give high feet enema (phosphate enema) over several days

If colic present –> Reduce stimulant laxative, add softener or osmotic agent

If colic not present –> Add or increase stimulant laxative +/- softener

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11
Q

Symptoms of IO

A

Vomiting, abdominal distention, abdominal pain, constipation, anorexia

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12
Q

Treatment of Complete I/O?

A

Pain relief with opioid (Morphine) +/- anticholinergic (Buscopan/ Hyoscine)

If N/V present, give Haloperidol, consider nasogastric tube feeding OR octreotide if high volume vomiting

Prokinetics contraindicated

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13
Q

Treatment of incomplete I/O?

A

Pain relief with Fentanyl, consider adding Buscopan if pain not relieved

If N/V present, give Metoclopramide

Continue to clear bowel with high fleet/ lactulose

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14
Q

I/O counselling points?

A
Take a low residue/ low fibre meal
Avoid food made with seeds, nuts or raw/dried fruit
Avoid whole grain breads and cereal
Avoid raw fruits/ vegetables
Avoid tough fibrous meat
Limit fat intake
Remove skin before cooking
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15
Q

Symptoms of diarrhoea

A

More than 3 unformed stool in 24 hrs

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16
Q

Causes of diarrhoea?

A

Diet related (spicy food/ alcohol, fruits),
treatment related, (Chemo, radio)
medication, (Laxatives, NSAIDs, Chemo, Abx)
overflow diarrhoea

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17
Q

Drugs for management of Laosai?

A

Codeine Phosphate
Diphenoxylate/ Atropine
Loperamide HCl
Octreotide

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18
Q

Doses for drugs used in Laosai?

A

Codeine - 30-60mg Q4-6h PRN

Diphenoxylate/ Atropine - 1-2 tabs, 3-4 times daily, MAX: 8 tabs

Loperamide HCL - 4-16mg daily.

Octreotide - 50-200mcg SC, 2-3 times daily

19
Q

Contraindication of laosai drugs?

A

Codeine - Caution in pt with COPD/Asthma, hepatic/renal dysfunction

Diphenoxylate/Atropine - Age <12, Infectious laosai, liver disease

Loperamide - Age <12, Infectious Laosai

Octreotide - Infectious laosai

20
Q

Counselling points for laosai?

A

Eat small frequent meals

Eat low fibre meals

Maintain good fluid intake

Avoid high fibre food, greasy/oily food, spicy food

Avoid coffee, tea, milk, milk products, alcohol and sweets

Gradually introduce proteins then fat into diet

21
Q

Causes of Dysponea?

A

Respiratory - Pleural effusion, PE/COPD exacerbation, Lymphangitis, Pneumonia, Collapse/Consolidation from Tumour

Cardiovascular - Pericardial effusion, Congestive Cardiac Failure

Abdominal - Liver failure leading to fluid overload, ascites causing diaphragmatic splinting

Systemic - Anemia

22
Q

List the class of meds used for treatment of dysponea

A

Oxygen, Opioids, Anxiolytic, Steroids, Treatment of secretion

23
Q

List the Anxiolytics used in Dysponea

A

S/L Lorazepam, IV/SC Midozalam (if terminal, unable to tolerate oral)

Escitalopram (if longer prognosis and has panic attack)

24
Q

List the steroid used in dysponea

A

Dexamethasone

25
List the agents used in treatment of secretion in dysponea
Nebulised NaCL 0.9% | Buscopan
26
List the opioid used in dysponea
Morphine, Fentanyl (if pt has renal impairments)
27
Can oxygen be used on non-hypoxic patients for dysponea
No, only hypoxic pts
28
Counselling points of dyspnoea
Learn breathing techniques, anxiety management techniques Break tasks into smaller bits, plan and pace activities, use aids if necessary Learn to find comfortable positions Open windows, use electric fans to increase sensation of moving air (Non-hypoxic pts only) Consider using breakthrough opioids prior to major movement and activities Consider joining support groups/ rehab groups
29
List the causes of N/V and the appropriate drug class to treat them
Clinical toxicity - Dopamine receptor antagonists Motility disorder - Prokinetics Intracranial disorders - Antihistamines, Anticholinergics Oral/pharyngeal/oesophageal irritation - Antihistamines, Anticholinergics Higher centres (Pain/fear/anxiety) - Optimise pain control, treat anxiety Multifactorial/ unknown - Appropriate anti-emetics Chemo - Refer local guidelines (LOL)
30
List the anti-emetic drugs used
Domperidone, Haloperidol, Metoclopramide, Ondansetron, Buclizine, Mirtazapine, Olanzapine
31
Screening tool for depression?
PHQ-9
32
Monoamines involved in depression?
Noradrenaline, Serotonin, Dopamine
33
Goal of pharmacologic treatment in depression?
Resolution of current symptoms, prevention of recurrences
34
Benefits of SSRI and Mirtazapine?
SSRI are better tolerated, Mirtazapine is well tolerated in patient with heart failure and the elderly
35
Causes of Xerostomia
Radiotherapy to neck and head region Surgery involving removal of salivary gland Certain chemo agents Oral infections
36
Medication used for xerostomia?
Pilocarpine 5-10ml TDS
37
List and describe the three types of delirium
Hyperactive - Increased arousal and agitation Hypoactive - Quiet and withdrawn Mixed
38
Causes of delirium?
Drugs - especially opioid toxicity, corticosteroids can cause florid delirium Drug withdrawal Dehydration, constipation, urinary retention Uncontrolled pain Liver or renal impairment Electrolyte disturbances (Na/glucose), hypercalcaemia alot more, i lz type
39
Risk factors for delirium
Visual and auditory impairment
40
Screening tools for delirium?
Mini-mental state examination (MMSE) | Confusion assessment method (CAM)
41
Drugs used for delirium?
Haloperidol - 1st choice Benzodiazepines - 2nd choice Lorazepam Midazolam Diazepam
42
Topical agents for pruritis?
``` Emollients/ Emollients with antipruritic agents Crotamiton 10% cream Capsaicin (0.025%) cream Topical corticosteroid Lidocaine patches ```
43
6 causes of pruritis?
Cholestasis, Uraemia, Paraneoplastic, Lymphoma, Systemic opioid induced pruritis
44
Drugs used to treat the 6 causes of pruritis?
Cholestasis - Rifampicin, Sertraline, Cholestyramine Uraemia - Gabapentin, Naltrexone, Mirtazapine Lymphoma - Prednisolone, Cimetidine, Mirtazapine Systemic opioid-induced - Chlorphenamine, Ondasetron Paraneoplastic - Paroxetine, Mirtazapine Unknown- Chlorphenamine, Paroxetine, Mirtazapine