ONCOLOGY and palliative Flashcards
WHAT IS INVOLVED IN THE ‘triple assessment’? FOR BREAST CANCER
mammogram
ultrasound
biopsy
What test is used for the national screening of bowel cancer for those aged 60-74?
faecal immunochemical test (FIT)
test for occult blood in stool
causes of false positive FIT
polyps and inflammatory bowel disease
which cancers commonly metastasise to bone
BLT with Mayo and a Kosher Pickle
Breast
Lung
Thyroid
Multiple myeloma
Kidney
Prostate
side effect of the following cytotoxic drugs:
cyclophosphamide
haemorrhagic cystitis
myelosuppression
transitional cell carcinoma
side effect of the following cytotoxic drugs:
doxorubicin
cardiomyopathy
side effect of the following cytotoxic drugs:
Vincristine
peripheral neuropathy
side effect of the following cytotoxic drugs:
bleomycin
lung fibrosis
side effect of the following cytotoxic drugs:
cisplatin
peripheral neuropathy
ototoxicity
hypomagnesaemia
causes of superior vena cava obstruction
common malignancies: small cell lung cancer, lymphoma
other malignancies: metastatic seminoma, Kaposi’s sarcoma, breast cancer
aortic aneurysm
mediastinal fibrosis
goitre
SVC thrombosis
management of SVCO
- alert oncology
- endovascular stenting
- steroids often given
what is Kartagener’s syndrome
a rare, autosomal recessive genetic ciliary disorder comprising the triad of situs inversus, chronic sinusitis, and bronchiectasis.
common sites of bone mets
- spine
- pelvis
- ribs
- skull
- long bones
common symptoms in palliative care
Breathlessness
constipation
N&V
Pain
common end of life symptoms
pain
secretions
breathlessness
agitation
N&V
management of breathlessness in palliative care
Treat underlying cause
O2 if hypoxic
low dose opioid (morphine sulphate IR 1mg PO PRN)
Mx of anxiety: short acting benzo eg lorazepam 0.5mg sublingual
non pharmacological: fan, CBT, relaxation techniques
Managament options for constipation in palliative care
NB: do not use bulk forming agents
- softening agents (lubricates stool)- eg. liquid paraffin, docusate sodium
- osmotic agents (pull liquid into stool)- lactulose, movicol
- stimulants (increase intestinal motility)- eg. senna
if pt already on one laxative and needs more, add one from a different class
causes of nausea in palliative care
Delayed gastric emptying (eg. gastrirtis, obstruction)
CNS cause
Chemical disturbance, renal failure, drug induced
Labrynth disturbance
psychological
best anti-emetic to use for each cause of nausea
delayed gastric emptying- metoclopromide/ domperidone
CNS and labrynth - cyclizine
chemical/ drug induced - haloperidol
post chemo, abdominal surgery and abdo radiotherapy- ondansertron (very constipating and causes QTc prolongation)
dose, frequency and route of anti emetics:
haloperidol
1.5mg continuous SC infusion
dose, frequency and route of anti emetics:
metoclopromide
30mg continuous SC infusion
dose, frequency and route of anti emetics:
cyclizine
150mg Continuous SC infusion
example drugs in each step of the pain ladder
step 1:
- paracetamol
- NSAIDS
step 2:
-codeine
- tramadol
- dihydrocodeine
step 3:
- morphine
- fentanyl
- diamorphine
how to calculate PRN dose
add up the total dose in 24hrs and divide by 6
conversion of step 2 to morphine
morphine 10x stronger than all step 2 drugs
conversion of oxycodone to morphine
oxycodone 2x more potent than morphine
calculating sustained/ modified release dose from PRN
times PRN dose by 6 then /2 as SR always 12hrly
which opioids are safe in renal failure
egfr <10
- fentanyl
- Alfentanil
- buprenorphine
egfr 20-40
- oxycodone
which opioids accumulate in the kidneys
morphine
codeine
diamorphine
tramadole
oxycodone a bit
anticipatory medications in end of life
Morphine sulphate (2.5-5mg SC 1-2hrly PRN) - pain and breathlessness
midazolam (2.5mg SC 1-2hrly PRN)- adgitation and breathlessness
glycopyrronium (0.2-0.4mg SC QDS PRN)- secretions
Haloperidol (0.5mg SC BD PRN) or cyclizine (50mg TDS SC PRN)- N&V
management of SCC if surgery inappropriate
ie if too frail or mets in multiple locations
external beam radiotherapy
bone pain treatment in boney metastasis
- opioids
- IV zolendronate
what investigation to perform before initiating trastuzumab therapy for HER2 pos breast cancer
Cardiomyopathy is an important risk of trastuzumab treatment and therefore all patients should have a baseline ECHO before treatment
