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Finals Revision > Gerries, Onc. and Palliative care > Flashcards

Gerries, Onc. and Palliative care Flashcards

1
Q

What drugs are typically used to treat secretions or bowel colic in palliative care? What drug class are they?

A

Hyoscine Hydrobromide or Hyoscine Butylbromide
They are antimuscarinic drugs

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2
Q

How do we differentiate between Parkinson’s Disease Dementia and Lewy Body Dementia?

A

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

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3
Q

Mx of PDD and LBD?

A

PDD = Levodopa
LBD = Rivastigmine/Donepezil or Memantine. AVOID antipsychotics in these patients

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4
Q

What blood tests should you perform in any person presenting with ?Dementia?

A

FBC, U&Es, LFTs, TFTs, CRP/ESR, Calcium, Glucose, Folate, B12

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5
Q

How do we manage riased ICP?

A

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)

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6
Q

What are the top 2 causes of superior vena cava obsturction?

A

Small cell lung cancer = most common
Also lymphoma

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7
Q

Which drugs should you always avoid in lewy body dementia?

A

HARM
Haloperidol
Antipsychotics
pRochlorperazine
Metoclopramide

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8
Q

Opioids can control pain and breathlessness in palliative care. Which should you use in renal failure?

A

Moderate failure = oxycodone
Severe failure = alfentanil/fentanyl/buprenorphine

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9
Q

How do we manage nausea and vomiting secondary to gastric dysmotility and stasis (but NOT obstruction)?

A

Metoclopromide/Domperidone if Meto causes EPSx

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10
Q

How do we manage nausea and vomiting secondary to chemo/radio therapy?

A

Ondansetron

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11
Q

How do we manage nausea and vomiting secondary to bowel obstruction?

A

Levopromazine

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12
Q

How do we manage nausea and vomiting secondary to intracranial cancers?

A

Cyclizine

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13
Q

How do we manage headaches associated with brain cancer?

A

Dexamethasone

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14
Q

What physiological changes occur in the brain in Alzheimer’s?

A

Cerebral atrophy of the cortex and hippocampus

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15
Q

How do we reduce mouth pain/discomfort in end of life care?

A

Benzydamine Hydrochloride Mouthwash/spray

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16
Q

How do we manage pressure ulcers?

A

Wound dressing, analgesia and nutritional assessment. Only give Abx if there are signs of infection

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17
Q

What is Pick’s disease?

A

Frontotemporal dementia characterised by personality changes and social misconduct without cognitive impairment in the <65s

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18
Q

How do we convert from codeine to morphine?

A

%10

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19
Q

How do we convert from oral to S/C morphine?

A

%2

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20
Q

Which type of HPV causes genital warts and which type causes cervical cancer?

A

HPV 6+11 cause warts
HPV 16+18 cause cancer

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21
Q

When should you switch from oral to s/c morphine in palliative care? How much can you increase oral morphine by before switching?

A

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

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22
Q

How do we treat metastatic bone pain?

A

Analgesia, Bisphosphonates or Radiotherapy

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23
Q

What are the most common sites of bone metastases?

A

The spine
Specifically the pelvis then the ribs then the skull

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24
Q

What is the tumour marker for colorectal cancer?

A

CEA

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25
Q

What are the tumour markers for thyroid cancer?

A

Medullary cancer = calcitonin
Follicular/Papillary cancer = thyroglobulin

26
Q

What are the Sx of digoxin toxicity?

A

GI disturbance (nausea, vomiting, abdo pain), dizziness, confusion, blurry/yellow vision and arrhythmias

27
Q

Which type of diuretics are associated with gout

A

Thiazide like diuretics

28
Q

Which scoring system can be used to confirm frailty?

A

PRISMA-7

29
Q

What are the tumour markers of testicular cancer?

A

Beta hCG and alpha fetoprotein (if AFP is raised will indicate a non-seminoma cancer)

30
Q

What is the tumour marker for ovarian cancer?

A

CA 125

31
Q

What is the tumour marker for pancreatic cancer?

A

CA 19-9

32
Q

What is the tumour marker for breast cancer?

A

CA 15-3

33
Q

What is the tumour marker for hepatocellular cancer?

A

Alpha Fetoprotein

34
Q

What is the tumour marker for melanoma and schwannoma?

A

S-100

35
Q

What is the tumour marker for squamous cell lung cancer, neuroblastoma and gastric cancer?

A

Bombesin

36
Q

What do PET scans assess?

A

Glucose uptake, therefor monitoring the metabolic activity of the lesion

37
Q

What is the dose for breakthrough pain with morphine?

A

1/6th the daily morphine requirement

38
Q

Sx of a SVC obstruction?

A

Dyspnoea (the most common Sx), oedema of the face, neck and arms, headache, visual disturbances and pulseless jugular venous distension

39
Q

Who should you be very cautious with when starting tricyclic antidepressants?

A

Those with dementia

40
Q

What type of drug is Ondansetron?

A

A 5HT3 antagonist

41
Q

How can we manage hiccups in palliative care?

A

Chlorpromazine or haloperidol

42
Q

What is the waterlow score used for?

A

Identifies patient’s risk of pressure sores

43
Q

How do we convert oral morphine to S/C diamorphine?

A

% 3

44
Q

What do the BRCA 1 and BRCA 2 genes increase the risk of?

A

BRCA1 = breast cancer and ovarian cancer
BRCA 2 = breast cancer, ovarian cancer and prostate cancer

45
Q

Which anti-cancer drugs can cause lymphoma?

A

Vincristine and Cisplatin

46
Q

Mx of agitation and confusion in palliative care?

A

1st line = haloperidol
2nd line = chlorpromazine and levopromazine
In the terminal phase of illness use S/C midazolam

47
Q

True or false benzos can help with delirium?

A

FALSE they worsen delirium

48
Q

What class of drug is memantine?

A

An NMDA antagonist

49
Q

Haloperidol is absolutely contraindicated in PD. What should you give to these patients if urgent management is required?

A

Quetiapine or Clozapine

50
Q

What type of drug is donepazil?

A

Acetyl cholinesterase inhibitor

51
Q

Mx of alzheimer’s?

A

1st line in mild-moderate disease = donepezil (NOT if bradycardia), galantamine and rivastigmine
2nd line or if severe = memantine

52
Q

What is gardener’s syndrome also known as? What procedure do most patients undergo?

A

AD familial colorectal polyposis
Most patients undergo colectomy to reduce the risk of colorectal cancer

53
Q

What is multiple endocrine neoplasia type II?

A

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

54
Q

What is multiple endocrine neoplasia type I?

A

AD
It is associated with hyperparathyroidism, pituitary tumours (e.g. prolactinoma) and pancreatic tumours (e.g. gastrinoma or insulinoma)

55
Q

S/Es of Asparagine?

A

Neurotoxicity

56
Q

S/Es of Cisplatin?

A

Ototoxicity, Nephrotoxicity and Hypomagnesaemia

57
Q

S/Es of Vincristine?

A

Peripheral neuropathy and lymphoma

58
Q

S/Es of Vinblastine?

A

Myelosuppresion

59
Q

S/Es of Bleomycin?

A

Pulmonary fibrosis

60
Q

S/Es of Doxorubicin?

A

Cardiotoxicity/Cardiomyopathy

61
Q

S/Es of Cyclophosphamide?

A

Nephrotoxicity, Bladder toxicity (e.g. haemorrhagic cystitis) and SIADH

62
Q

S/Es of Methotrexate?

A

Nephrotoxicity, Myelosuppression, Liver fibrosis and oral mucositis

Finals Revision (23 decks)

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