Palliative Care, ASPHO Flashcards
(45 cards)
where is the vomiting centre located?
medulla
receptors in chemo trigger zone?
dopamine
5HT3=serotonergic
NK1…want to block these to prevent nausea
recptors in vomiting centre?
5HT2, 5Ht3, histamine, n-acetylcholine
causes of n/v in oncology?
- chemo, antibiotics, opioids
- mucositis, constipation
- pscych/anticipatory
- increased ICP
- hypercalcemia
non-pharm options for n/v?
provide small meals hypnoiss breathing techniques, guided imagery aromatherapy (ginger, peppermint) acupressure P6 point avoid discomforting smells
give 4 classes of pharm therapies for n/v and an example for each?
-serotonic 5-HT3 inhibitors: ondansetron, gran, palo
-anti-dopaminergics (D2)
metoclopramide
haloperidol
olanzapine
-anti-Histamine H1
diphenhydramine, dimehydrinate
cyproheptadine
-Acetylcholine blocker
scoplamine
-Neurokinin 1 antagonist (NK)
aprepitant (can’t give with cyclophos, ifos)
-Benzos
lorazapeam for anticipatory nausea
-steroids (dexamethasone)
-IVF
-THC: dronabinol
-octreotide for bowel obstruction, other constipation meds
high emetogenic risk: how do you determine meds?
-is dex permitted or no?
-child’s age? if >6 mos, can get aprepitant…
-getting chemo that interacts with aprep?
Therefore, end up with 5HT3 inhibitor, dex if you can give it, and aprep if you can give it…..if <6 mos, 5HT3 + dex alone….if dex contraindicated and >6 mos and chemo ok, give 5HT3+ aprep….and if can’t get aprep as well, then 5HT3 inhibitor alone (palonosteron)
mod emetogenic risk: how you determine?
if can give dex: dex + 5Ht3 inhibitor…if can’t, then try 5HT3 + aprep as long as can receive aprep…otherwise 5HT3 alone
low emetogenic risk: give what?
ondans or gran
if minimal emetogenic risk, give what?
5HT3 inhibitor as needed (don’t need ppx)
what is nociceptive pain?
neural tarnsmission activate by mechanical, chem, or thermal damage to the body tissue, produces phsyiological/endocrine presonse separate from cogntiive/emotional repsonse…eg: break your arm
neuropathic pain=?
results from abnormal nerve function due to nerve invasion or inflammation
2 ways to quantify pain in kids?
Visual analog scale
FLACC scale= face, leg, activity, cry, consolability
principles for managing nociceptive pain?
- if having pain all teh time, set up regular pain meds, not PRN
- adapt tx to the child and their needs
- give meds by appropriate route
- 2-step strategy: step 1= mild, step 2= mod-severe
step 1 pain: manage how?
ibuprofen and/or acetaminophen…maybe cox2 inhibitor=toradol= ketorlac
step 2 pain: manage how?
morphine or other opioid like fentanyl, hydromoprh
tramadol can’t give to whom?
<12 yrs; history of seizures
4 side effects of opioids? and ways to manage?
- constipation…give REGULAR meds, like senna
- sedation…wait it out (imporves with time), remove other sedating medications
- pruritus…tx with naloxone >antihistamine
- nausea…tx with dopamine antagonist or 5HT3 antagonist
- urinary retention: nalbuphine or bladder cath
- hyperalgesia: dose reductioni or reduction to diff opioid
- myoclonus: reduce or rotate opiod, give benzo
reasons to rotate opiods?
- renal failure (stop morphine/oxycodone and go to fentayl or methadone)
- too many side effects with poor pain control (otherwise if good pain control, go down on dose by 20%)
- opioid-induced hyperalgesia or myoclonus
tolerance?
need to increase dose of opioids over time (this is a physio process)
withdrawal symptoms for stopping opioid too fast? 5
sweating diarrhea restlessness rhinorrhea hypertension
neuropathic pain relief takes how long to tx with neuro meds?
4-6 weeks!
4 types of meds for neuropathic pain?
- gabapentinoids, eg gabapentin, pregabalin
- TCAs, eg amitriptyline, notryptyline
- SNRIs, eg venlafaxine, duloxetine
- Antiepileptic drugs, eg topiramate
- local anethestics, eg: lidocaine or ketamine
- opioids (methadone) if NOT affectively treated with other meds
non-med ways to manage pain? 5
- physical tehrapy
- acupuncture
- massage
- heat/cold
- guided imagery
- hyponosis
