Palliating other symptoms

Question 1

What non- drug approaches can be taken to improve breathlessness?

Answer 1

• position patient upright
• airflow across face e.g fan or open window
• only give O2 if hypoxic
• physio/ OT

Question 2

How do you treat breathlessness than hasn’t responded to non-drug approaches?

Answer 2

• Consider low dose morphine e.g.
• Oramorph 1-2mg orally PRN
• morphine 1-2mg SC PRN

If there’s a lot of anxiety related to breathless consider lorazepam or midazolam

• Lorazepam 0.5mg-1mg SL PRN
• Midazolam 2.5mg SC PRN

Question 3

Where does Haloperidol act?

Answer 3

D2 receptors in CTZ

Question 4

Where does Metoclopramide act?

Answer 4

D2 receptors in CTZ

5 HT3 receptors vagus afferent

Question 5

Where does Cyclizine act?

Answer 5

ACh receptors and H1 receptors in vomiting centre

Question 6

Where does levomepromazine act?

Answer 6

D2 receptors in CTZ
5HT3 receptors in vomiting centre
ACh receptors and H1 receptors in vomiting centre

Question 7

Where does ondansetron act?

Answer 7

5HT3 receptors in vagus afferent

Question 8

Which would be the best anti-emetic for chemical causes of N+V?

Answer 8

Haloperidol

Question 9

Which would be the best anti-emetic for N&V caused by gastric stasis?

Answer 9

Metoclopramide

Question 10

Which would be the best anti-emetic for functional bowel obstruction

Answer 10

Cyclizine (slows peristalsis to reduce perforation)

plus Dexamethosone can help if due to oedema

Question 11

What would be the best anti-emetic for N+V caused by raised ICP/ intracerebral cause

Answer 11

Cyclizine + Dexamethasone

Question 12

What would be the best drug to help with N+V caused by anxiety / fear / anticipation?

Answer 12

Benzodiazepines

Question 13

Which would be the best anti-emetic for post operative / radiotherapy N+V?

Answer 13

Ondansetron - rarely used 1st line in cancer patient

Question 14

What is the best way to manage N+V caused by constipation?

Answer 14

Laxatives + metoclopramide

Question 15

What are some of the risk factors for chemotherapy induced N+V

Answer 15

• female
• <50 yrs old
• past history of N&V(in pregnancy/ motion sickness)

Question 16

Which drug can be used for those high risk of developing N&V before starting chemotherapy?

Answer 16

Aprepitant
Normally taken night before / morning of
Usually only taken at the beginning of the cycle

Question 17

Which laxatives are stimulants?

Answer 17

Senna

Bisacodyl

Question 18

Which laxatives are stool softeners?

Answer 18

Docusate

Question 19

Which laxatives are stool softeners / stimulants

Answer 19

Sodium picosulfate

Question 20

Which laxatives are osmotic?

Answer 20

Movicol
Laxido

(Lactulose too but tends not to be used in oncology)

Question 21

Name a softening suppository

Answer 21

Glycerin

Question 22

Name a stimulant suppository

Answer 22

Bisacodyl

Question 23

How is malignant bowel obstruction managed surgically?

Answer 23

• Endoscopic stenting
• Venting gastrostomy to decompress
• Avoid NG if possible

Question 24

How is malignant bowel obstruction managed if not a surgery candidate?

Answer 24

SC dexamethasone injections together with opioid analgesia, cyclizine and octreotide delivered over 24 hours via a subcutaneous syringe driver.

• Limit oral fluids to sips = give IVF
• Correct any electrolyte imbalance
• NG tube for large volumes of vomiting