Haem/Onc Flashcards
Antiphospholipid syndrome Rx in pregnancy
Initially aspirin alone
LMWH once foetal heartbeat on USS, usually discontinued at 34 weeks
APLS in pregnancy complications
Recurrent miscarriage Intrauterine growth restriction Pre eclampsia Placental abruption Pre term delivery VTE
Oral Opiate conversion rates
Codeine to morphine
Tramadol to morphine
Morphine to oxycodone
Divide by 10
Divide by 10
Divide by 1.5
Oral to sub cut morphine conversions
Oral morphine to subcut
Oral morphine to subcut diamorphine
Oral oxycodone to subcut diamorphine
Divide by 2
Divide by 3
Divide by 1.5
Cyclophosphamide MoA
Alkylation agent, causes cross linking of DNA
Cyclophosphamide side effects
Haemorrhagic cystitis
Myelosupression
TCC
Bleomycin MoA
Degrades preformed DNA
Bleomycin side effects
Lung fibrosis
Doxorubicin MoA
Stabilises dNA-topoisomerase II complex - inhibits DNA and RNA synthesis
Doxorubicin side effects
Cardiomyopathy
Methotrexate MoA
Inhibits dihydrofolate reductase and thymidylate synthesis
Anti folate
MTX side effects
Myelosupression
Live fibrosis
Lung fibrosis
Fluorocil (5-FU) MoA
Pyridimine analogue - induces cell cycle arrest and apoptosis by blocking thymidylate synthesis (during S phase)
Fluorouracil (5-FU) side effects
Myelosupression
Mucositis
Dermatitis
6 mecaptopurine MoA
Purine analogue, activated by HGRPTase, decreases purine synthesis
6 mecaptopurine side effects
Myelosupression.
Cytarabine MoA
Pyridimine antagonist. Interferes with DNA synthesis at S phase and inhibits DNA polymerase
Cytarabine side effects
Myelosupression
Ataxia
Vincristine/vinblastine MoA
Inhibits formulation of microtubules
Vincristine side effects
Reversible peripheral neuropathy
Paralytic ileum
Vinblastine side effects
Myelosupression
Cisplatin MoA
Causes cross linking in DNA
Cisplatin side effects
Ototoxicity
Peripheral neuropathy
Hypomagnesaemia
Hydroxyurea (hydroxycarbamide) MoA
Inhibits ribonucleotide reductase, decreases DNA synthesis
Hydroxyurea (hydroxycarbamide) side effects
Myelosupression
G6PD demographics and inheritance
More common in Mediterranean and African
XLR
G6PD pathophys
Decreased G6PD leads to decrease in glutathione, increased red cell susceptibility to oxidative stress
Features of G6PD (5)
?neonatal jaundice Intravascular haemolysis Gallstones ?splenomegaly Heinz bodies on bloods films
G6PD Dx
Enzyme assay
G6PD triggers
Antimalarials (primaquine) Ciprofloxacin Sulphur drugs Favs beans Infection
Vitamin B12 absorption
Bound to intrinsic factor (produced by parietal cells in stomach)
Active absorption in terminal ileum
Minor passive absorption not bound to IF
Causes of B12 deficiency
Pernicious anaemia Post gastrectomy Poor diet Disorders of terminal ileum - Crohns, blind loop Metformin (rare)
B12 deficiency Rx
If no neuro involvement 3 weekly IM hydroxycobalamin for 2 weeks, then once every 3 months
NB - if also folate deficient Rx B12 first to prevent SCDC
ECOG score 0
Fully active, at predisease functionality
ECOG 1
Restricted in strenuous physical activity but ambulatory and able to carry out work of light sedentary nature - house work, Office work
ECOG 2
Ambulatory, capable of all self care , unable to carry out any work Activites
Up and about >50% waking hours
ECOG 3
Limited self care
In bed >50% waking hours
ECOG 4
Completely disabled
No self care
Totally confined to bed/chair
ECOG 5
Dead
CML translocation
T(9;22) Philadelphia chromosome
-> Abelson proto-oncogene moved to BCR gene on Ch22
BCR-ABL fusion protein has excess tyrosine kinase activity
Poor prognostic indicator in ALL
Acute promyelocytic leukaemia (M3) genetics
Fusion of PML and RAR alpha genes
Burkitts Lymphoma genetics
T(8;14)
MYC oncogene translocated onto an immunoglobulin gene
Mantle cell lymphoma genetics
t(11;14)
Deregulation of cyclinD1 (BCL1) gene
Squamous cell cancer features (4)
Typically central
Associated with PTHrP secretion
Strongly associated with finger clubbing
Hypertrophic pulmonary osteoarthropathy
Adenocarcinoma lung features (3)
Typically peripheral
Most common lung ca in non smokers
Majority who develop it are smokers however
Large cell lung Ca features (3)
Typically peripheral
Anaplastic, poorly differentiated, poor prognosis
May secrete bHCG
Acute haemolytic transfusion reaction MoA
ABO incompatibility Massive intravascular haemolysis Symptoms minutes after transfusion - fever - Abdo and chest pain - agitation - Hypotension
Acute haemolytic transfusion rxn Rx
Stop transfusion
Fluid resus with NS
Inform lab
Complications
DIC, AKI
Non haemolytic febrile reaction MoA
HLA incompatibility
Often result of sensitisation by previous pregnancies or transfusions
Pathphysiology of hypercoagulable state in pregnancy
Increased factor VII, VIII, X
Decreased protein S
Uterus presses on IVC -> venous stasis in legs
VTE Rx in pregnancy
Sub cut LMWH
Indications for Rx in CLL (6)
Progressive marrow failure - development of worsening anaemia and/or thrombocytopenia
Massive >10cm or progressive LAN
Massive >6cm or progressive splenomegaly
Progressive lymphocytosis >50% inc over 2 months, or lymphocyte doubling time <6 months
Autoimmune cytopenias - eg ITP
Systemic Sx - weight loss >10% in 6/12, Fever >38 for >2/52, extreme fatigue, night sweats
CLL management
If no indication for Rx them monitor with regular FBC
Fludarabine, cyclophosphamide and rituximab (FCR)
AML M0
Undifferentiated
AML M1
Without maturation
AML M2
With granulocytic maturation
AML M3
acute promyelocytic
AML M4
granulocytic and monocytic maturation
AML m5
Monocytic
AML M6
Erythroleukaemia
AML M7
Megakaryoblastic
Pigment laden macrophages on colonoscopy
Laxative abuse
Rasburicase MoA, indication
recombinant version of urate oxidase, coverts uric acid to allantoin
Preventing tumour lysis syndrome
