1 / 10

MANAGEMENT OF NAUSEA AND VOMITING IN PALLIATIVE CARE

MANAGEMENT OF NAUSEA AND VOMITING IN PALLIATIVE CARE. INCIDENCE OF NAUSEA AND VOMITING IN TERMINAL CANCER PATIENTS. Nausea: 50 - 60 % Vomiting: 30 %. MECHANISM OF NAUSEA AND VOMITING. vomiting centre in reticular formation of medulla activated by stimuli from:

autumn-tate
Download Presentation

MANAGEMENT OF NAUSEA AND VOMITING IN PALLIATIVE CARE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MANAGEMENT OF NAUSEA AND VOMITING IN PALLIATIVE CARE

  2. INCIDENCE OF NAUSEA AND VOMITING IN TERMINAL CANCER PATIENTS Nausea: 50 - 60 % Vomiting: 30 %

  3. MECHANISM OF NAUSEA AND VOMITING • vomiting centre in reticular formation of medulla • activated by stimuli from: • Chemoreceptor Trigger Zone (CTZ) • area postrema, floor of the fourth ventricle • outside blood-brain barrier (fenestrated venules) • Upper GI tract & pharynx • Vestibular apparatus • Higher cortical centres

  4. VOMITING CENTRE Cortex CTZ GI Vestibular

  5. CAUSES OF NAUSEA & VOMITING CHEMORECEPTOR TRIGGER ZONE VESTIBULAR CORTICAL PERIPHERAL • drugs • opioids • chemo • etc... • biochemical • ­Ca++ • renal failure • liver failure • sepsis tumor opioids anxiety association ­ICP • radiotherapy • chemotherapy • GI irritation • inflammation • obstruction • paresis • compression

  6. PRINCIPLES OF TREATING NAUSEA & VOMITING • Treat the cause, if possible and appropriate • Environmental measures • Antiemetic use: • anticipate need if possible • use adequate, regular doses • aim at presumed receptor involved • combinations if necessary • anticipate need for alternate routes

  7. 5HT 5HT 5HT AREA STIMULUS RECEPTORS Chemoreceptor trigger zone Drugs, Metabolic D 2 M H 1 Motion/ Position Vestibular H1 M VOMITING CENTRE Visceral Abdominal organs D 2 ­ ICP H Cortex 1 EFFECTOR ORGANS (usually use decadron) 5HT H1 M D2 Dopamine Serotonin Histamine Muscarinic

  8. RELATIVE ANTIEMETIC RECEPTOR AFFINITIES 1250

  9. EXAMPLES OF ANTIEMETIC USE • haloperidol 0.5 - 1 mg po/sq/iv q6-12h • prochlorperazine 5 - 20 mg po/pr/iv q4-8h • CPZ 25 - 50 mg po/pr/iv q6-8h • methotrimeprazine 5 - 10 mg po/sl/sq q4-8h • metoclopramide 10 - 20 mg po/sq/pr q4-8h • domperidone 10 mg po q4-8h • scopolamine patch (Transderm-Vâ) • metoclopramide 10 - 20 mg po/sq/pr q4-8h • domperidone 10 mg po q4-8h • cisapride 10 mg po tid-qid DOPAMINE ANTAGONISTS ANTIMUSCARINIC PROKINETIC

  10. EXAMPLES OF ANTIEMETIC USE • dimenhydrinate 25 - 100 mg po/pr/[sq] q4-8h • promethazine 25 mg po/iv q4-6h (Not sq) • meclizine 25 mg po q6-12h • ondansetron 4 - 8 mg bid-tid po/sq/iv • granisetron 0.5 –1 mg po/sq OD - bid • dexamethasone 2 - 4 mg po/sq/iv OD-qid • lorazepam 0.5 - 1 mg po/sl q4-12h H1 ANTAGONISTS SEROTONIN ANTAGONISTS MISCELLANEOUS

More Related