cancer & palliative care

Question 1

What is myelosuppression?

Answer 1

reduction of WBC, RBC & platelets

Question 2

When does myelosuppression usually occur after chemotherapy?

Answer 2

7-10 days after chemo Tx

Question 3

How long does it take to recover from myelosuppression?

Answer 3

20 days

Question 4

What does low erythrocytes cause and Tx?

Answer 4

• anaemia
• blood transfusions or Fe

Question 5

What is low WBC and risk?

Answer 5

• neutropenia
• risk of infection

Question 6

What is low platelets and risk?

Answer 6

• thrombocytopenia
• bruising & bleeds

Question 7

What is neutropenic sepsis?

Answer 7

neutropenia with elevated temp +- Sx of infection (medical emergency)

Question 8

ABX for neutropenic sepsis

Answer 8

Tazocin 48hrs

Question 9

key Sx of sepsis

Answer 9

decreased urine output

Question 10

What antiemetic to NEVER give in palliative care?

Answer 10

ondansetron

Question 11

antiemetic for metabolic causes (hypercalcaemia)/renal failure/opioid causes in palliative care

Answer 11

haloperidol

Question 12

antiemetic for gastric stasis & functional bowel obstruction (bowel working) in palliative care

Answer 12

metoclopramide
OR
domperidone

(prokinetics - promote movement)

Question 13

antiemetic for mechanical bowel obstruction (bowel not working) /raised intracranial pressure (brain tumour)/ motion sickness in PC

Answer 13

cyclizine

Question 14

antiemetic if all others have failed in PC

Answer 14

levomepromazine

Question 15

meds to discontinue/keep in PC

Answer 15

DISCONTINUE
- statins
- alendronic acid etc.
- laxatives
- diuretics
- PPIs
CONTINUE
- analgesics
- anti-emetics
- anticonvulsants
- steroids
(to alt route - SC)
RX
- PRN meds for anticipated Sx for SC admin

Question 16

anticipatory med for pain 1st, 2nd & 3rd line

Answer 16

• morphine = 1st line
• oxycodone - morphine not tol/renal impairment, can use GFR 10-30
• alfentanil - GFR<10 (not renally excreted)

Question 17

problem with alfentanil

Answer 17

• very short half life
• needs to be Rx with oxycodone for BT pain

Question 18

anticipatory med for agitation/unsettled/ fidgeting/shaking/delirium

Answer 18

• midazolam
  (BDZ)
• levomepromazine - midazolam ineffective or requires more than 60mg/24hrs (antiemetic, drowsy)

Question 19

anticipatory med for secretions

Answer 19

• hyoscine hydrobromide - 400mcg SC PRN (max 2400mcg/24hrs), sedative
• hyoscine butylbromide - 20mg SC PRN (max 120mg/24hrs
• if don’t work - glycopyrronium injection

Question 20

What can be used for bowel colic/bladder spasm?

Answer 20

hyoscine