Gerries, Onc. and Palliative care Flashcards
What drugs are typically used to treat secretions or bowel colic in palliative care? What drug class are they?
Hyoscine Hydrobromide or Hyoscine Butylbromide
They are antimuscarinic drugs
How do we differentiate between Parkinson’s Disease Dementia and Lewy Body Dementia?
Both present with tremor, rigidity, postural instability, fluctuating cognition and hallucinations
In PDD they must have had a PD diagnosis for at least 1 year
In LBD the Parkinsonism and cognitive impairment occur within 1 year and cognitive symptoms occur first
Mx of PDD and LBD?
PDD = Levodopa
LBD = Rivastigmine/Donepezil or Memantine. AVOID antipsychotics in these patients
What blood tests should you perform in any person presenting with ?Dementia?
FBC, U&Es, LFTs, TFTs, CRP/ESR, Calcium, Glucose, Folate, B12
How do we manage riased ICP?
Dexamethasone if secondary to malignancy or brain abscess
Mannitol if unknown cause
Acetazolamide if secondary to IIH (an obese female with HTN, papilloedema and on the COCP)
What are the top 2 causes of superior vena cava obsturction?
Small cell lung cancer = most common
Also lymphoma
Which drugs should you always avoid in lewy body dementia?
HARM
Haloperidol
Antipsychotics
pRochlorperazine
Metoclopramide
Opioids can control pain and breathlessness in palliative care. Which should you use in renal failure?
Moderate failure = oxycodone
Severe failure = alfentanil/fentanyl/buprenorphine
How do we manage nausea and vomiting secondary to gastric dysmotility and stasis (but NOT obstruction)?
Metoclopromide/Domperidone if Meto causes EPSx
How do we manage nausea and vomiting secondary to chemo/radio therapy?
Ondansetron
How do we manage nausea and vomiting secondary to bowel obstruction?
Levopromazine
How do we manage nausea and vomiting secondary to intracranial cancers?
Cyclizine
How do we manage headaches associated with brain cancer?
Dexamethasone
What physiological changes occur in the brain in Alzheimer’s?
Cerebral atrophy of the cortex and hippocampus
How do we reduce mouth pain/discomfort in end of life care?
Benzydamine Hydrochloride Mouthwash/spray
How do we manage pressure ulcers?
Wound dressing, analgesia and nutritional assessment. Only give Abx if there are signs of infection
What is Pick’s disease?
Frontotemporal dementia characterised by personality changes and social misconduct without cognitive impairment in the <65s
How do we convert from codeine to morphine?
%10
How do we convert from oral to S/C morphine?
%2
Which type of HPV causes genital warts and which type causes cervical cancer?
HPV 6+11 cause warts
HPV 16+18 cause cancer
When should you switch from oral to s/c morphine in palliative care? How much can you increase oral morphine by before switching?
Keep oral for as long as the patient is able to swallow.
You can increase the oral dose by 30-50% as necessary to control pain in palliative care
How do we treat metastatic bone pain?
Analgesia, Bisphosphonates or Radiotherapy
What are the most common sites of bone metastases?
The spine
Specifically the pelvis then the ribs then the skull
What is the tumour marker for colorectal cancer?
CEA
What are the tumour markers for thyroid cancer?
Medullary cancer = calcitonin
Follicular/Papillary cancer = thyroglobulin
What are the Sx of digoxin toxicity?
GI disturbance (nausea, vomiting, abdo pain), dizziness, confusion, blurry/yellow vision and arrhythmias
Which type of diuretics are associated with gout
Thiazide like diuretics
Which scoring system can be used to confirm frailty?
PRISMA-7
What are the tumour markers of testicular cancer?
Beta hCG and alpha fetoprotein (if AFP is raised will indicate a non-seminoma cancer)
What is the tumour marker for ovarian cancer?
CA 125
What is the tumour marker for pancreatic cancer?
CA 19-9
What is the tumour marker for breast cancer?
CA 15-3
What is the tumour marker for hepatocellular cancer?
Alpha Fetoprotein
What is the tumour marker for melanoma and schwannoma?
S-100
What is the tumour marker for squamous cell lung cancer, neuroblastoma and gastric cancer?
Bombesin
What do PET scans assess?
Glucose uptake, therefor monitoring the metabolic activity of the lesion
What is the dose for breakthrough pain with morphine?
1/6th the daily morphine requirement
Sx of a SVC obstruction?
Dyspnoea (the most common Sx), oedema of the face, neck and arms, headache, visual disturbances and pulseless jugular venous distension
Who should you be very cautious with when starting tricyclic antidepressants?
Those with dementia
What type of drug is Ondansetron?
A 5HT3 antagonist
How can we manage hiccups in palliative care?
Chlorpromazine or haloperidol
What is the waterlow score used for?
Identifies patient’s risk of pressure sores
How do we convert oral morphine to S/C diamorphine?
% 3
What do the BRCA 1 and BRCA 2 genes increase the risk of?
BRCA1 = breast cancer and ovarian cancer
BRCA 2 = breast cancer, ovarian cancer and prostate cancer
Which anti-cancer drugs can cause lymphoma?
Vincristine and Cisplatin
Mx of agitation and confusion in palliative care?
1st line = haloperidol
2nd line = chlorpromazine and levopromazine
In the terminal phase of illness use S/C midazolam
True or false benzos can help with delirium?
FALSE they worsen delirium
What class of drug is memantine?
An NMDA antagonist
Haloperidol is absolutely contraindicated in PD. What should you give to these patients if urgent management is required?
Quetiapine or Clozapine
What type of drug is donepazil?
Acetyl cholinesterase inhibitor
Mx of alzheimer’s?
1st line in mild-moderate disease = donepezil (NOT if bradycardia), galantamine and rivastigmine
2nd line or if severe = memantine
What is gardener’s syndrome also known as? What procedure do most patients undergo?
AD familial colorectal polyposis
Most patients undergo colectomy to reduce the risk of colorectal cancer
What is multiple endocrine neoplasia type II?
AD
It is associated with phaeochromocytoma and medullary thyroid cancer
IIa is also associated with primary hyperparathyroidism, IIb is not but it is associated with neuromas
What is multiple endocrine neoplasia type I?
AD
It is associated with hyperparathyroidism, pituitary tumours (e.g. prolactinoma) and pancreatic tumours (e.g. gastrinoma or insulinoma)
S/Es of Asparagine?
Neurotoxicity
S/Es of Cisplatin?
Ototoxicity, Nephrotoxicity and Hypomagnesaemia
S/Es of Vincristine?
Peripheral neuropathy and lymphoma
S/Es of Vinblastine?
Myelosuppresion
S/Es of Bleomycin?
Pulmonary fibrosis
S/Es of Doxorubicin?
Cardiotoxicity/Cardiomyopathy
S/Es of Cyclophosphamide?
Nephrotoxicity, Bladder toxicity (e.g. haemorrhagic cystitis) and SIADH
S/Es of Methotrexate?
Nephrotoxicity, Myelosuppression, Liver fibrosis and oral mucositis
