Chloe's Flashcards
Name some sulphonureas..
Gliclazide
Glimepiride
Glibenclamide
Tolbutamide
Name some DPP4 inhibitors..
Alogliptin, linagliptin, saxagliptin, sitagliptin
What is an impaired fasting glucose?
After fasting glucose is between 6.1 and 7 mmol
If above 7 ?diabetes
What is impaired glucose tolerance?
2 hour value between 7.8 and 11.1
How often should HBA1C levels be measured in type 2 diabetes?
Every 2-6 months until stable
Then every 6 months
What are reed sternburg cells characteristic of?
Hodgekins lymphoma
What is the most common type of Hodgkin’s lymphoma?
Nodular sclerosing
What deciles is Hodgkin’s most common in?
3rd
7th
What type of Hodgkin’s is associated with lacunar cells?
Nodular sclerosing
What are the B symptoms in Hodgkin’s?
Weight loss over 10% in 6 months
Fever above 38
Night sweats
What 3 things on an X-ray suggest COPD?
Hyperinflation
Flattened hemidiaphragms
Hyperlucent lung fields
What is neoadjuvent chemotherapy?
Used to reduce tumour size before planned surgical intervention
What is primary chemotherapy?
Where it is in operable but the chemo may lead to possible surgery
What is adjuvent chemotherapy?
Chemo after surgery to treat occult microscopic metastasis
Give and example of prophylactic chemotherapy?
Tamoxifen for insitu breast ca before invasive carcinoma is seen
How are chemotherapy doses calculated?
Using body surface area
What are the principles of chemotherapy?
Administer drugs in combinations
Give tx in cycles
Administer optimal dose
Only use maintenance when necessary
What cancers is chemo really good in? (Over 50% cure)
Hodgkin’s
Testicular ca
ALL
Paeds ca (leukaemia, lymphoma, sarcoma)
When might single dose chemo be appropriate?
In palliative care as it is rarely curative
What are the main aims of combination chemotherapies?
Maximise cell kill
Minimise toxicity in non -tumours cells
Minimise development of resistance
How do you minimise the toxicity of chemo?
Give drugs where their toxic side effects don’t overlap
Give chemo in cycles
Normal length of the gap in between chemo cycles?
3-4 weeks
What is the difference between primary resistance and acquired resistance to chemo?
Primary - where the initial malignant clone is resistant
Secondary - the tumour mutates to become malignant
How can high dose chemotherapy be defined?
Chemo requiring bone marrow support
How many days after the start if a cycle of chemo does the patient get leukopenia and thrombocytopenia?
10-14 days
What is the nadir?
The lowest point in thrombocytopenia/ leukopenia
At what levels of neutrophils does the risk of infection become significant?
Less than 0.5x10^9/1
How longs does haemolytic recovery take?
3-4 weeks
What chemo drugs are associated with peripheral neuropathy?
Platinum drugs
What are the most carcinogenic chemo drugs?
Alkylating agents
Procarbazine
What are the clinical signs of thrombocytopenia?
Petechial haemorrhage
Spontaneous nose bleeds
Corneal haemorrhage
Haematuria
At what levels of platelet counts require regular transfusions?
Anything below 20 x10^9/L
What platelet count requires emergency transfusion?
What are the complications of this?
Less than 10 x 10^9/L
Risk of intracranial haemorrhage and bleeding
Neutropenia is a medical emergency, what is the immediate management of neutropenia with associated fever?
Broad spectrum antibiotics
What would be considered neutropenia?
WCC
Before starting ACE inhibitors what is it important to measure?
How often should this be measured?
U&Es
Creatinine
eGFR
Before starting, after each dose increase, and every three months
In a patient with LVSD you would like to start ACE inhibitors, in what scenario should you NOT prescribe unless pt has seen a specialist?
If the pt has suspected valve disease
Name 2 beta blockers that are licensed for heart failure?
Bisoprolol
Carvedilol
What do you need to monitor when you give aldosterone antagonists?
Potassium
Creatinine
eGFR
Name an example of an aldosterone antagonist..
Spironolactone
In radiotherapy what is the gross tumour volume?
Te size of the tumour actual tumour demonstrated by CT
In radiotherapy what is the clinical target volume?
The area around the GTV where there may be microscopic spread
In radiotherapy what is the planning target volume?
The extra space around the CTV where radiation is aimed to account for daily movements in the tumour
What is the characteristic of bone pain?
Dull ache over a large area
Or
Tenderness over a bone
What exacerbates bone pain?
Weight bearing
Movement
Name three treatment a for bone pain
NSAIDs (dixlofenac 50mg TDS)
Radiotherapy
Bisphosphonates
Describe characteristic visceral pain..
Dull deep poorly localised pain
What drugs can be given to reduce the oedema in raised ICP headache?
Corticosteroids
Name a non-renally excreted opiate
Fentanyl
What groups of patients should you reduce the dose of morphine?
Elderly
Renally impaired
Frail patients
What is the normal starting dose of MST if they have been on max strength cocodamol?
MST 20mg bd
What is the max strength cocodamol?
30 mg codeine
500mg paracetamol
How much intermediate release should be given for breakthrough pain in a patient on long acting morphine?
1/6 of the total 24hr dose
Name 2 stimulant laxatives
Senna
Dantron
Name 3 stool softeners
Lactulose
Sodium docusate
Movicol
When shod stimulant laxity was not be used?
If the patient has colic
Name an antispasmodic
Hyocine butylbromide
In radiotherapy what is the gross tumour volume?
Te size of the tumour actual tumour demonstrated by CT
In radiotherapy what is the clinical target volume?
The area around the GTV where there may be microscopic spread
In radiotherapy what is the planning target volume?
The extra space around the CTV where radiation is aimed to account for daily movements in the tumour
What cancers most commonly cause spinal cord compressions?
Breast
Bronchus
Prostate