3.7 Palliative Care - Comeau

goal of palliative care for cancer pts

anticipate, prevent, and reduce suffering

pts are usually put in hospice when they have ____ life expectancy

<6 month

purpose of hospice

intense palliative care

hospice does not…

include anticancer therapy, prolong life, or hasten death

dyspnea definition

unpleasant or uncomfortable respiratory sensation

what can lead to a cancer pt having dyspnea?

increased respiratory burden

impaired respiratory anatomy

increased O2 needs

nonpharmacological treatment options for dyspnea

avoid lying flat, improve air circulation in room, minimize exercising for pt, relaxation, stress relief, breathing techniques

goal of treating dyspnea due to cancer

decrease discomfort

gold standard tx for dyspnea in cancer pts

morphine

morphine doses for dyspnea in cancer pt:

1. if pt is naiive

2. if pt is tolerant

1. low

2. high

alternative to morphine for dyspnea in cancer pts

benzos or furosemide (both at low doses)

respiratory congestion or secretions are common in pts with ____ cancers

pulmonary or brain

what can cause respiratory congestion or secretions in cancer pts

inability to swallow

reduced gag reflexes

buildup of secretions from saliva and bronchi

pharma tx option for respiratory congestion or secretions in cancer pts

anticholinergics

name the anticholinergic agents indicated for respiratory congestion or secretions in cancer pts

atropine 1% eye drops

glycopyrrolate

hyoscyamine

scopolamine patch

what is the route of admin for the following anticholinergics:

1. atropine

2. glycopyrrolate

3. hyoscyamine

4. scopolamine patch

1. eye drop

2. IV or subq

3. po or eye drop

4. transdermal behind ear

which anticholinergic for respiratory congestion or secretions has the

1. fastest onset

2. longest onset

1. atropine eye drops

2. scopolamine patch

ADE of anticholinergics

sedation, confusion, heart palpitations, constipation

definition of anorexia/cachexia

weight loss >10% compared to weight prior to illness OR over 6 months

anorexia/cachexia in cancer pts is related to…

early mortality

anorexia/cachexia nonpharma tx in cancer pts

nutrition consult

education

modify diet

if a cancer pt is suffering from anorexia/cachexia and has months to years prognosis, consider pharmacologic tx if…

nonpharma fails

if a cancer pt is suffering from anorexia/cachexia and has days to months prognosis, how to treat?

meds and nonpharma

if a cancer pt has gastroparesis, how to treat

metoclopramide (avoid in complete bowl obstruction)

if a cancer pt has low to no appetite which is aiding in anorexia, what are the two treatment options?

olanzapine

dexamethasone

olanzapine ADE

sedation

opioid induced constipation in cancer pts is defined as

stool difficult to pass, less frequent, and hard compared to normal bowel habits

goal of tx for opioid induced constipation treatment

one non forced bowel movement every 1-2 days

tx options for drug induced constipation

osmotic laxative + stimulant laxative

what is the osmotic laxative used for drug induced constipation

PEG

what are the stimulant laxatives used for drug induced constipation

senna or bisacodyl

resistant opioid induced chemo treatment

enema prn

both diphenhydramine and ondansetron cause…

constipation

T or F:
docusate is good for constipation

F

cancer induced fatigue nonpharma tx

physical activity

energy conservation

monitor fatigue level

if nonpharma options fail for cancer induced fatigue, what medication is next in line?

methylphenidate