Medicine D Flashcards
Positive Coomb’s test with IgG indicates what?
Extravascular haemolysis
Treatment for DIC
Platelets, fresh frozen plasma, cryoprecipitate
Genetic abnormality in CML?
The 9:22 translocation (the Philadelphia chromosome)
Haemorrhagic cystitis on what chemo drug?
Cyclophosphamide
Indications for a syringe driver:
- Poor swallow
- Nausea and vomiting
- Reduced consciousness
- Requiring more than two doses of an injectable medication in 12 hours
- Impaired absorption by oral route e.g bowel obstruction.
Reassure does not equate to EOL or active dying.
What are the side effects of glycopuronium / hyoscine butylbromide?
Anti-cholinergics therefore:
1. Dry mouth / eyes
2. Urinary retention
3. Constipation
Management of breathlessness in palliative patients:
- Sit up
- Box breathing
- Fan on trigeminal nerve
- Oxygen / CPAP / BIPAP
- Morphine breakthrough dose
What cancers most commonly metstasise to the spine?
Breast, prostate, lung
How to manage MSCC?
- Lie the patient flat and contact the MSCC co-ordinator, complete the proforma.
- MRI whole spine
- Dexamethasone 16mg + ppi cover.
- Stop any NSAID’s and aspirin
- LMWH
- WHO analgesic ladder
MSCC OSCE
Practice it!
How to manage analgesia in MSCC if the WHO ladder has failed?
Bisphosphonates
Radiotherapy
Surgery
Side effects of radiotherapy for MSCC
External beam - effective at treating pain for 12months, but does not reduce mechanical pain which can progress to instability and vertebral collapse.
What should be co-prescribed with morphine / any opioid?
A laxative and consider an anti-emetic and
Other than an MRI what investigations are needed for a patient with MSCC?
Glucose - steroids can cause hyperglycemia (DKA)
LDH - associated with a poor prognosis
Unknown primary? - do a myeloma screen
Bladder scan
Obvs baseline bloods and do a PR
Management of a paracetamol overdose:
Management
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation
Benzodiazepine overdose management?
Flumazenil
The majority of overdoses are managed with supportive care only due to the risk of seizures with flumazenil. It is generally only used with severe or iatrogenic overdoses.
Lithium overdose management
Management
mild-moderate toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity
sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretionvvvv
Heparin overdose
Protamine sulphate
Beta-blocker overdose
Atropine
Glucagon used in resistant cases
Risks and complications of syringe drivers:
Local reaction
Pump failure
Interference
Causes of nausea and vomiting:
- Physiological - constipation, hepatomegaly, cough, raised ICP.
- Iatrogenic - Chemo, radiotherapy, opioids, abx.
- Metabolic - hypercalcemia, hyponatraemia, uraemia, liver failure, hyperkalaemia.
- Psychological - Anxiety, fear, fatigue.
Principles of treating nausea and vomiting:
- Assess underlying cause - reverse if possible.
- Dietary alterations
- Non-drug measures: Hypnosis, acupressure, relaxation.
Medication!
Summary of laxative prescribing:
Rectal = quicker result
Oral = patient preference
Stimulant - if reduced frequency of stool
Softener - if hard stools
Mixed - if both
Enema
What interventions can improve a patients appetite in palliative care?
Trial of steroids
Management of a sore mouth e.g. candida
Accept this is a part of the EOL process
