Oncological complications and treatment Flashcards
What are the medical complications of N+V
Dehydration
Electrolyte disturbances
Risk of aspiration pneumonia
Define acute nausea and vomiting from chemo
Within 24 hours of receiving chemo
Define delayed nausea and vomiting with chemo
24 hours to 7 days post chemo
What is the most effective way of controlling post chemo nausea and vomiting?
NK1 antagonist
5Ht3 antagonist
Dexamethasone
Combination of all is best
Where in the brain is the chemo receptor trigger zone
Area postrema
What drug is most effective for acute vomiting
5HT3 antagonist (ondansetron or granisetron)
What is anticipatory n+v and how do you treat it
Conditioned response to sights and smells
Lorazepam good treatment
Which antiemetic constipate and what would you use instead
Ondansetron and cyclisine constipate so use metoclopramide instead
Which opioid would you use in renal impairment
Fentanyl
Codeine is what of morphine
1/10
Tramadol is what of morphine
1/10th to 1/5th
Oxycodone is what of morphine
Double the strength
Hydro morphone is how many times stronger than morphine
7.5
Methadone is how many times stronger than morphine
10
How can you treat myoclonus as a result of opioids
Benzos
What is good for bone pain
NSAIDS
What is good for pain relief which will stimulate appetite
Corticosteroids
What is good for neuropathic pain?
TCAs/ amitriptylline
What is the most common metabolic oncology emergency
Hypercalcaemia >2.5mmol/l
How does hypercalcaemia present
Dehydration Constipation Seizure Weakness Myopathy Ecg changes Polyuria
Treat hypercalcaemia
2.5-4 litres of saline in 24 hours
Bisphosphonates (IV panidronate)
Why does SIADH occur in oncology
Chemo or small cell lung cancer
What is the main sign on bloods of SIADH
<133 mol
What’s the criteria for SIADH
Normovolaemia
Normal renal adrenal and thyroid function
Urine osmolalityb>100
Urine Na>30
No drugs causing hyponatraemia
Improvement of Na following water restriction
Treat SIADH
Fluid restrict
Treat cancer
Demeclocycline
Radicalar pain in oncology means
Cord compression
What’s revthe urgent signs of cord compression
Loss of bowel or bladder control
Severe or increasing numbness
Severe pain and weakness that spreads into one or both legs making it hard to walk or get out of a chair
What are the main symptoms of malignant pericardial effusion
Becks triad
What are the symptoms of SVC obstruction
Dyspnoea Headache Facial oedema Venous distension Light headed Cough
What is the main aim of investigations in SVC obstruction
To distinguish whether the blockage from within (clot; foreign body like in dwelling catheter; tumour in vessel like renal cancer) or out with and compression from mass like lung cancer or lymphoma
How do you treat SVC obstruction
Stenting or thrombolysiswif clot
What is the definition of neutropenia sepsis
Sepsis and neutrophils <0.5 (or <1 if chemo given within last 21 days)
Check for neutropenia sepsis if had recently chemo and a fever >38
What may mask a temp spike
Steroids
67% of organisms causing neutropenia fever and gram what
Negative
Peripheral lines may become infected by what organisms
Staph aureus
Coag neg staph
Which abx in neutropenia sepsis
IV tazocin plus or minus gentamicin
If neutropenia sepsis and pen allergy give
Teicoplanin and aztreonam
What is pancoast syndrome?
Apical Lung ca and ipsilateral horners (miosis enophthalmos sunken eye ptosis and unilateral swelling
What sort of lung cancer can be treated by radiotherapy
NSCLC
What is the most common side effect of radiotherapy
Tiredness
