Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EXAM 2 > Onc/Pall > Flashcards

Onc/Pall Flashcards

4.5% 9x2

1
Q

SVC obstruction

  • features?
  • causes?
A
  • dyspnoea commonest, swelling of face/arms/neck, conjunctival & periorbital oedema, headache worse in AM, visual disturbance, pulseless jugular venous distension
  • commonly: NSCLC, lymphomas (LN on CXR)
  • other ca: metastatic seminoma, Kapok’s sarcoma, breast ca
  • aortic aneurysm (CT disease, uncontrolled HTN)
  • mediastinal fibrosis
  • enlarged multi nodular goitre
  • SVC thrombosis (+ve d-dimer)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Rx of SVC obstruction?

A
  • > Dex + PPI, balloon venoplasty, stenting
  • > (if small cell: chemo + RT
  • > if NSCLC: RT)
  • eg even though lymphomas are highly chemo-sensitive (and therefore chemo should be planned if poss), stenting should be done until chemo can take affect - optimise Hb, platelets, coag. If end-stage, stents can still become blocked
  • RT causes increased swelling acutely, although long-term shrinkage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

1st choice in pall care to treat hiccup AND nausea?

A

METOCLOPRAMIDE

- also baclofen, nifedipine, chlorpromazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Rx of hiccups in palliative care?

A

CHLORPROMAZINE - for intractable hiccups

  • haloperidol, gabapentin also used
  • DEXAMETHASONE also used esp if HEPATIC lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Concern of spinal metastases - what scan?

A

MRI WHOLE spine

  • 30-50^ have multi-level involvement by the time of presentation
  • within 24h if ?SCC
  • of no neuro involvement, can be within 7d - but important to detect before any neuro compromise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Sx/findings of spinal metastases?

A
  • unrelenting lumbar back pain
  • any thoracic/cervical back pain
  • worse withs needing, coughing, straining
  • nocturnal
  • ass with tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Commonest chemo regime for SCLC?

A

ETOPOSIDE & CISPLATIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Common side effect of Cisplatin?

A

Hypomagnasaemia -> cramps, tremor, cardiac arrhythmias, confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MoA of Cyclophosphamide?

Adverse effects?

A

Alkylating: causes cross-linking in DNA

  • haemorrhagic cystitis
  • myelosuppression
  • TCC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MoA of Bleomycin?

Adverse effect?

A

Degrades preforemd DNA (cytotoxic Abx)

- lung fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MoA of Doxorubicin?

Adverse effect?

A

Stabilises DNA-topoisomerase II complex, inhibiting DNA & RNA synthesis (cytotoxic Abx)
- cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MoA of Methotrexate?

Adverse effects?

A

Inhibits dihydrofolate reductase & thymidylate synthesis - antimetabolite

  • myelosuppression
  • mucositis
  • liver & lung fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MoA of 5-Fluorouracil?

Adverse effect?

A

Primidine analogue inducing cell cycle arrest & apoptosis by blocking thymidylate synthase (works during S phase) - antimetabolite

  • myelosuppression
  • mucositis
  • dermatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MoA of 6-mercaptopurine?

Adverse effect?

A

Antimetabolite - purine analogue activated by HGPRTase, decreasing purine synthesis
- myelosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MoA of Cytarabine?

Adverse effect?

A

Antimetabolite - Pyrimidine antagonist, interfering with DNA synthesis specifically at the S phase, and inhibits DNA polymerase

  • myelosuppression
  • ataxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MoA of Vincristine/Vinblastine?

Adverse effects?

A

Inhibits formation of microtubules

  • Cristine: peripheral neuropathy (reversible), paralytic ileus
  • Blastine: myelosuppression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MoA of Docetaxel?

Adverse effect?

A

Prevents microtubule depolymerisation & disassembly, decreasing free tubular
- neutropenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MoA of Cisplatin?

Adverse effects?

A

Causes cross-linking in DNA

  • ototoxicity
  • peripheral neuropathy
  • low Mg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MoA of Hydroxyurea/hydroxycarbamide?

Adverse effect?

A

Inhibits ribonucleotide reductase, decreasing DNA synthesis

- myelosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Analgesia in palliative pain relief with renal failure

- what is appropriate?

A

In CKD: Alfentanil, buprenorphine and fentanyl are preferred

  • Fentanyl patch is appropriate to replace regular long-acting MST
  • Oxycodone is ok in moderate renal failure, but only as breakthrough (MR should be avoided)
  • Pregabalin is ok at reduced dose
  • Alfentanil & methadone safe even in severe impairment (SC) - alfentanil may be appropriate if unstable pain requiring dose titration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Starting treatment when prescribing analgesia in palliative care?

A

20-30mg MR a day with 5mg prn morhine if no comorbidities

  • oral in preference to transdermal patches
  • laxatives for everyone
  • nausea often transient (antiemetic if it persists)
  • drowsiness usually transient, adjust dose if it doesn’t settle
22
Q

Rx for metastatic bony pain?

A
  • strong opioids, bisphosphonates or RT
  • give opioids, refer everyone to oncologist for consideration of RT etc
  • denosumab may be used too
23
Q

converting oral codeine to oral morphine?

oral tramadol to oral morphine?

A

Both divide by 10

24
Q

Difference between oxycodone & morphine?

A

Oxycodone generally causes less sedation, vomiting & pruritus than morphine, but more constipation

25
Q

converting oral morphine to oral oxycodone?

A

Divide by 1.5-2

26
Q

converting fentanyl 12 patch to oramorph?

A

= 30mg oral morphine

27
Q

converting buprenorphine 10 patchy to oral morph?

A

= 24mg oral morphine /24h

28
Q

oral morphine to SC morphine?
oral morphine to SC diamorphine?
oral oxycodone to SC diamorphine?

A

oramorph-> SC morphine divide by 2
oramorph -> SC diamorphine divide by 3
oral oxycodone-> SC diamorphine divide by 1.5

29
Q

3 main types of NSCLC?

A
  1. SCC - central, PTHrP-> hypercalcaemia, stonrgly ass with clubbing, HPOA
  2. Adenocarcinoma - peripheral, commonest type that occurs in non-smokers but majority who get it are smokers
  3. Large cell ca - peripheral, anaplastic poorly differentiated tumours with poor prognosis, may secrete beta-hCG
30
Q

Features of SCC?

A
  • back pain is earliest & commonest - may be worse on lying down/coughing
  • LL weakness
  • sensory changes - loss & numbness
  • neuro signs depending on level
  • above L1: UMN signs in legs with sensory level
  • below L1: LMN signs in legs with peri-anal numbness. tendon reflexes increased below the level, absent at the level
31
Q

Rx of SCC?

A
  • high dose Dex + PPI
  • urgent onc assessment for RT/surgery
  • neurological status at time of Rx initiation is set predictor of neuro outcome
  • surgery superior to RT in retaining/regaining neuro function & relieving pain
  • eg surgery then RT if suitable is ideal in someone with a good performance status
  • if RT is appropriate as 1st line it would be e.g. 20Gy in 5 daily fraction for Rx, or less e.g. single dose 8Gy to help pain control
  • chemo can have a role in chemo-sensitive malignancies e.g. SCLC or germ cell tumours
32
Q

What Rx is effective in refractory chemo-induced vomiting?

A

Dexamethasone + Ondansetron
(if low risk, metoclopramide is 1st line)
- dexamethasone is the most useful agent in preventing the delayed phase of chemo-induced emesis

33
Q

SOL identified as solitary on contrast enhanced CT brain suspicious of brain metastasis - next step?

A

Start 16mg Dexamethasone
Arrange urgent MRI brain - to assess extent of intracranial disease
- give anticonvulsants if presenting with seizure activity

34
Q

Adverse effects of cisplatin: causes X-linking of DNA?

A

ototoxicity
peripheral neuropathy
low Mg

35
Q

Adverse effects of hydroxyurea/hydroxycarbamide: inhibits ribonucleotide reductase, decreasing DNA synthesis?

A

Myelosuppression

36
Q

Adverse effects of Irinotecan: inhibits topoisomerase I which prevents relaxation of supercoiled DNA?

A

Myelosuppression

37
Q

Adverse effects of Vincristine/Vinblastine that inhibits formation of microtubules?

A

Vincristine: reversible peripheral neuropathy, paralytic ileus
Vinblastine: myelosuppression

38
Q

Adverse effects of Docetaxel: prevents microtubule depolymerisation & disassembly, decreasing free tubulin?

A

Neutropaenia

39
Q

Adverse effects of MTX: inhibits dihydrofolate reductase & thymidylate synthesis?

A

Myelosuppression, mucositis, liver fibrosis, lung fibrosis

40
Q

Adverse effects of 5-FU fluorouracil: pyrimidine analogue inducing cell cycle arrest & apoptosis by blocking thymidylate synthase during S phase?

A

myelosuppression, mucositis, dermatitis

41
Q

Adverse effects of 6-mercaptopurine: purine analogue activated by HGPRTase, decreasing ourine synthesis?

A

Myelosuppression

42
Q

Adverse effects of Cytarabine: pyrimidine antagonist: interferes with DNA synthesis specifically at S phase & inhibits DNA polymerase?

A

Myelosuppression

ataxia

43
Q

Adverse effects of Bleomycin: degrades preformed DNA?

A

Lung fibrosis

44
Q

Adverse effects of Doxorubicin: stabilises DNA-topoisomerase II complex, inhibits DNA & RNA synthesis?

A

Cardiomyopathy

45
Q

Adverse effects of Cyclophosphamide: alkylating agent causing cross-linking of DNA?

A

Haemorrhagic cystitis, myelosuppression, TCC

46
Q

Broad-spectrum anti-emetic which blocks lots of different receptors (e.g. ACh, DA, 5HT)?

A

Levomepromazine

47
Q

Opioid that can be used 3rd line in complex pain not responding to other analgesics, that acts as a neuropathic agent by NMDA antagonism?

A

Methadone

48
Q

What acute complication is it important to monitor for with Ketamine?

A

Raised intracranial pressure

  • monitor headache, vomiting, papilloedema
  • it can be used for neuropathic pain poorly responsive to titrated opioids & oral adjuvant analgesics esp when abnormal pain sensitivity
  • bladder & liver dysfunction can occur with long term use
49
Q

RT-induced mucositis - occurs esp following RT to head & neck
- often they’ll have a PEG inserted prior to Rx to help maintain oral intake
Rx?

A

LA gels
Benzydamine mouthwashes
who-based analgesic ladder for liquid pain relief

50
Q

Causes of lymphoedema?

A 
1ry = inherited
2ry = surgery, radiation, infection classically filariasis, or injury resulting in damage to lymphatic system
51
Q

Capecitabine = oral analog of 5-FU which is broken down predominantly by dihydropyrimidine dehydrogenase
- what happens in toxicity?

A
  • eg deficiency of the enzyme

- diarrhoea, weakness, desquamation, pancytopenia, electrolyte abnormalities

EXAM 2 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions