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Finals > Oncology and Palliative > Flashcards

Oncology and Palliative Flashcards

1
Q

Name some mechanisms that chemotherapy works?

A 
DNA cross links - platinum
Damage tubulin - vinca alkaloids
Topoisomerase 1 and 2 inhibitors
Antimetabolites
Free radical generator
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2
Q

what is chemotherapy?

A

cytotoxic drugs used to kill cancer cells

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3
Q

SE of chemotherapy?

A

myelosuppression, alopecia, infertility, fatigue

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4
Q

How do we work to prevent anaphylaxis with chemotherapy?

A

give steroids/antihistamines
slower infusion rates
specialist nurses on sight

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5
Q

Name some oncological emergencies

A

extravasation
coronary artery spasm
neutropenic sepsis

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6
Q

Name some late effects of chemotherapy

A 
Infertility
early menopause
atherosclerosis
HF/lung damage
chemo brain
secondary cancers
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7
Q

what is extravasation during chemotherapy?

A

if chemotherapy cannula accidently moves SC and is administered it can cause necrosis of large patches of skin

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8
Q

what is coronary artery spasm during chemotherapy?

A

typically occurs with 5FU
looks like ACS on ECG
stop infusion and involve cardiology
give NITRATES

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9
Q

what anti-emetics can you give to patients struggling with N&V during chemo?

A

metoclopromide, domperidone

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10
Q

why is there an increased risk of haemorrhage in cancer patients?

A

chemo + disease = reduced platelets
cancer can erode vessels
low numbers of clotting factors

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11
Q

How do you manage SCC in a cancer patient?

A

IV dexamethasone

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12
Q

how do you manage constipation/diarrhoea in a cancer patient?

A

loperamide, laxative

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13
Q

how does BM suppression present?

A

THROMBOCYTOPENIA - easy bruising and bleeding
ANAEMIA - fatigue and pallor
NEUTROPENIA - neutropenic sepsis

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14
Q

what is the definition of neutropenic sepsis?

A

neutrophil count <1.0 and a fever >37.5 in a patient undergoing chemotherapy (increased Rx due to myelosuppression)

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15
Q

what do you give to a patient with suspected neutropenic sepsis?

A

Tazocin

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16
Q

Ix for a patient with suspected neutropenic sepsis?

A

FBC/UE/LFT/Cr/CRP/lactate/blood cultures/urine cultures/swab central line

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17
Q

how do we try and increase appetite of cancer patients?

A

steroids

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18
Q

how do we manage painful spinal mets?

A

analgesia, bisphosphonates, palliative radiotherapy, vertebroplasty

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19
Q

how can we manage stomatitis?

A

difflam mouthwash

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20
Q

name some types of immunotherapy?

A

MAbs, interferons, interleukins, oncolytic virus therapy, cancer vaccines

21
Q

name some side effects of immunotherapy treatment?

A

hepatitis - deranged LFTs/jaundice
colitis - perforation, pain and blood in stools
pneumonitis - cough/SoB

22
Q

name some cancer functional assessments? why are they important

A

ECOG performance status (0 = fully active –> 5 = dead)
clinical frailty score

important because it strongly correlates to outcome

23
Q

what can we use to dictate outcome predictions for cancer patients

A

cancer functional assessments
exercise tolerance
daily housework
Albumin/Cr/Hb/liver and renal function/pulm function/TNM staging

24
Q

Indications for radiotherapy

A

medically unfit for surgery, anatomically unrescectable, close to vital structures, adjuvent to reduce recurrence

25
Q

what is radiotherapy?

A

high dose X rays to destroy cells (cancer cells can’t repair themselves very well but normal cells can.)

26
Q

name some different modalities for radiotherapy?

A

external beam, electrons, brachytherapy

27
Q

acute SE of radiotherapy?

A 
local sunburn effect
fatigue
reduced taste
pneumonitis
erythema
irritation
28
Q

late effects of radiotherapy?

A 
scarring
infertility
lymphodoema
delayed healing
reduced salivary flow
hypothyroid
29
Q

what are the features of a benign tumour?

A

localised, non invasive, resembles normal tissue and encapsulated

30
Q

what are the features of a malignant tumour?

A

invasive, metastatic, rapid growth, poorly defined border, necrosis

31
Q

mechanism of hypercalcaemia of malignancy? 3 mechanisms

A
  1. secretion of PTH by tumour
  2. local realease of factors increasing osteoclast proliferation
  3. autonymous production of calcitriol by lymphoma
32
Q

Mx of hypercalcaemia of malignancy?

A

IV normal saline
Bisphosphonates
Furosemide

33
Q

What is SVC obstruction? and what is the commonest cause?

A

venous return for the head/thorax/upper extremities is obstructed, which increases venous pressure

commonest cause: cancer (lung cancer and lymphoma)

34
Q

Symptoms of SVC obstruction?

A

oedema of face and upper extremities, facial plethora, dysponea and cough, distended chest and neck veins, , raised JVP

35
Q

Ix for SVC obstruction?

A

CXR, CT thorax and contrast, USS upper extremities

36
Q

what is tumour lysis syndrome?

A

combination of metabolic and electrolyte abnormalities occuring spontaneously in cytotoxic treatment due to excessive cell lysis.

37
Q

What are the metabolic abnormalities in tumour lysis syndrome and what do these cause?

A

HYPERURICAEMIA - increased uric acid crystals –> AKI
HYPERPHOSPHATAEMIA - urinary obstruction
HYPERKALAEMIA - arrhythmia
HYPOCALCAEMIA - cramps/tetany

38
Q

presentation of tumour lysis syndrome?

A

syncope, chest pain, dyspnoea, N&V, abdo urinary colic, muscle weakness, tetany

39
Q

what causes carcinoid syndrome? what are the features?

A

increased serotonin from neuroendocrine tumours

flushing/diarrhoea, wheeze palpitations, abdo pain

40
Q

what does palliative medicine focus on?

A

physical, psychological and spiritual - supportive care/EoL/terminal care/bereavement support

41
Q

name some antiemetics and where they act?

A

bowels - domperidone
bowels and brain - ondasetron
biochem and brain - haloperidol
brain - cyclizine

42
Q

Name some simple analgesics and their side effects?

A

paracetamol - liver impairment and cachexia

NSAIDS - renal impairment, GI bleeds, asthma

43
Q

Name 3 weak opioids

A

codeine, dihydrocodeine, tramadol

44
Q

name some strong opioids?

A

morphine, diamorphine, oxycodone, buprenorphine, fentanyl

45
Q

Common SE of opioids?

A

constipation, sedation, nausea, dry mouth, resp depression

46
Q

which opiods are best for renal impairment?

A

fentanyl, buprenorphine

47
Q

name some alternative adjuvant analgesics?

A 
antidepressants e.g TCAs
pregabalin
antispasmodics e.g. baclofen
steroids
benzos
bisphosphonates
48
Q

signs that a patient is dying?

A 
weight loss and reduced appetite
fatigue
reduced mobility
social withdrawan
pulse changes, mottled, cool peripheries
noisy secretions and laboured breathing
49
Q

Name some symptoms in the dying patient and how you would manage them?

A 
PAIN - PRN morphine syringe driver and patch
BREATHLESSNESS - PRN opioid
SECRETIONS - PRN buscopan
N&V - Haloperidol
AGITATION - midazolam

Finals (21 decks)

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