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Education in Palliative and End-of-life Care - Oncology

The. EPEC-O. TM. Education in Palliative and End-of-life Care - Oncology. Project. The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

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Education in Palliative and End-of-life Care - Oncology

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  1. The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

  2. EPEC – Oncology Education in Palliative and End-of-life Care – Oncology Module 3p Symptoms –Nausea / vomiting

  3. Nausea / vomiting . . . • Definition • Nausea is an unpleasant subjective sensation of being about to vomit • Vomiting is the reflex expulsion of gastric contents through the mouth

  4. . . . Nausea / vomiting • Impact very distressing: • Awareness of nausea • Inability to keep food or fluids down • Acid and bitter tastes • Unpleasant smells of vomitus

  5. Key points • Pathophysiology • Assessment • Management

  6. Pathophysiology • Nausea • Subjective sensation (easily learned) • Stimulation • Gastrointestinal lining, CTZ, vestibular apparatus, cerebral cortex • Vomiting • Neuromuscular reflex

  7. Pathophysiology ChemoreceptorTrigger Zone (CTZ) Cortex Vestibular apparatus Vomiting center • Neurotransmitters • Acetylcholine • Dopamine • Histamine • Neurokinin • Serotonin GI tract

  8. Metastases Meningeal irritation Movement Mental anxiety Medications Mucosal irritation Mechanical obstruction Motility Metabolic Microbes Myocardial Causes

  9. Assessment • When • Acute versus chronic • Intermittent or constant • Associated with sights or smells • Eating patterns • Bowel patterns • Medications

  10. Dopamine antagonists Antihistamines Anticholinergics Serotonin antagonists Neurokinin antagonists Prokinetic agents Antacids Cytoprotective agents Other medications Management Gralla R, et al. J Clin Oncol, 1999.

  11. Chemotherapy nausea • Acute • < 24 hr • Chemoreceptor trigger zone • Serotonin release in the gut • Delayed • 24 hr (may be days) • Unclear mechanism

  12. Chemotherapy emetogenicity

  13. Haloperidol Prochlorperazine Droperidol Thiethylperazine Promethazine Trimethobenzamide Metoclopramide Olanzapine Perphenazine Dopamine antagonists

  14. Histamine antagonists (antihistamines) • Diphenhydramine • Meclizine • Hydroxyzine

  15. Acetylcholine antagonists(anticholinergics) • Scopolamine

  16. Serotonin antagonists • Ondansetron • Granisetron • Dolasetron • Palonosetron

  17. Neurokinin-1 antagonists • Aprepitant

  18. Prokinetic agents • Metoclopramide • Domperidone • Macrolide antibiotics, eg, erythromycin

  19. Antacids • Antacids • H2 receptor antagonists • Cimetidine • Famotidine • Ranitidine • Proton pump inhibitors • Omeprazole • Lansoprazole

  20. Other medications • Dexamethasone 6 – 20 mg PO daily • Tetrahydrocannabinol 2.5 – 5 mg PO tid • Lorazepam 0.5 – 2 mg PO q 4 – 6 h • Octreotide 10 mg / hr IV / SC infusion • or 100 mg SC q 8 h for bowel obstruction

  21. Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience

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