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Flashcards in Palliative Care Deck (25)
1

Describe the WHO pain ladder

1. non opiod +/- adjuvant
2. Mild opioid +/- non opiod +/- adjuvant
3. Strong opioid +/-nonopiod +/- adjuvant

2

give examples if mild opiates

codeine, tramadol, dihydorcodeine

3

give examples of strong opiods

diamorphine
morphine
fentanyl
oxycodone

4

what is the CTZ

chemoreceptor trigger zone - receives inputs from blood-borne drugs or hormones, and communicates with other structures in the vomiting center to initiate vomiting

5

where is the CTZ locate

on the floor of the fourth ventrical in the medulla

6

What neurotransmitters are involved in vomiting

dopamine
5HT
NK1
GABA
Ach
Opioid

7

what are the characteristics of vomiting due to impaired gastric emptying

not usually nauseated - then suddenly very nauseated - large volume vomits - feels better after vomit

5HT/D2 mediated

8

What are the characteristics of regurgitation vomiting

due to obstruction or compression of the oesophagus - dysphagia, pain, coughing, stridor

5HT/D1 mediated

9

What are the characteristics of chemical/metabolic reasons for vomiting

persistant nausea, little relief from vomiting
(calcium, sodium and urea raised)

CTZ/D1/NK - CTZ mediated
GABA/NK1 - cerebral

10

characteristics of bowel obstruction vomiting

intermittent large vomits, colic, reduced bowel movements

5HT/D2 = gut mediated

11

characteristics of vomitning due to cerebral disease

worse in morning, headache

GABA/H1/NK1 - cerebral

12

characterisitcs of vestibular vomiting

worse on movement, vertigo, tinnitus

Ach/H1 - vestibular

13

What type of vomiting does oncological treatments produce

Cerebral - GABA/NK1
CTZ- 5HT/d2

14

treatment of vomiting due to impaired gastric emptying

metoclopramide
domperidone

15

treatment of regurgitation vomiting

dexamethasone

16

treatment of chemical/metabolic vomiting

haloperidol
metoclompramide
levomepromazine

17

treatment of vomiting due to cerebral disease

dexamethasone
cyclizine

18

treatment of vestibular vomiting

cyclizine
prochlorperazine

19

treatment of vominting due to oncological treatments

ondansetron
metoclopramide
dexamethasone
lorazepam

20

Which part of the bowel is more commonly obstructed in malignant bowel obstruction

small intestine> large

21

name drugs that are used as anti secretory agents

hyoscine butylbromide (buscopan)
octreotide

22

how does octreotide work

it is a sommatostatin analogue - inhibits GI secretions

23

NAME some stool softeners

sodium docusate
movicol

24

what laxative should be used if the patient has refractory opioid induced constipation

methylnatrexone

25

how should medications generally be delivered in palliation

parenteral not oral