Oncology and Palliative Care Flashcards
Alkylating Agents
Example (1)
Mechanism of action
Adverse effects
cyclophosphamide
causes cross-linking in DNA
Haemorrhagic cystitis, myelosuppression, transitional cell carcinoma
Cytotoxic Antibiotics
Examples (2) plus MOA and Side effects
Bleomycin
- Degrades preformed DNA
- Lung fibrosis
Doxorubicin
- Stabilizes DNA-topoisomerase II complex inhibits DNA &
RNA synthesis
- Cardiomyopathy
Methotrexate
Class
MOA
Side effects
Antimetabolite
Inhibits dihydrofolate reductase and thymidylate synthesis Myelosuppression, mucositis, liver fibrosis, lung fibrosis
Fluorouracil (5-FU)
Class
MOA
Side effects
Antimetabolite
Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)
Myelosuppression, mucositis, dermatitis
6-mercaptopurine
Class
MOA
Side effects
Antimetabolite
Purine analogue that is activated by HGPRTase, decreasing purine synthesis
Myelosuppression
Cytarabine
Class
MOA
Side effects
Antimetabolite
Pyrimidine antagonist. Interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase Myelosuppression, ataxia
Vincristine, vinblastine
Class
MOA
Side effects
‘spindle poisons’
Inhibits formation of microtubules
Vincristine: Peripheral neuropathy (reversible), paralytic ileus
Vinblastine: myelosuppression
Docetaxel
Class
MOA
Side effects
‘Spindle Poisons’
Prevents microtubule depolymerisation & disassembly, decreasing free tubulin
Neutropaenia
Irinotecan
Class
MOA
Side effects
Topoisomerase inhibitors
Inhibits topoisomerase I which prevents relaxation of supercoiled DNA
Myelosuppression
Cisplatin
MOA
Side effects
Causes cross-linking in DNA
Ototoxicity, peripheral neuropathy, hypomagnesaemia
Hydroxyurea (hydroxycarbamide)
MOA
Side effects
Inhibits ribonucleotide reductase, decreasing DNA synthesis
Myelosuppression
Name the associated cancer
CA 125
Ovarian cancer
Name the associated cancer
CA 19-9
Pancreatic cancer
Name the associated cancer
CA 15-3
Breast cancer
Name the associated cancers
Alpha-feto protein (AFP)
Hepatocellular carcinoma, teratoma
Name the associated cancer Carcinoembryonic antigen (CEA)
Colorectal cancer
Name the associated cancers
S-100
Melanoma, schwannomas
Name the associated cancers
Bombesin
Small cell lung carcinoma, gastric cancer, neuroblastoma
Mx for nausea and vomiting with intracranial tumours
Dexamethasone
conversion of oral to subcut morphine
divide dose by 2
Mx of nausea and vomiting associated with chemotherapy
metoclopramide is first-line
Second-line is 5HT3 receptor antagonists e.g. ondansetron
can add dexamethasone
Risk factors for N&V with chemo
anxiety
age less than 50 years old
concurrent use of opioids
the type of chemotherapy used
convert from oral morphine to diamorphine s/c
divide by 3
SVCO Features
dyspnoea - most common swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen headache: often worse in the mornings visual disturbance pulseless jugular venous distension
SVCO Causes (9)
common malignancies: non-small cell lung cancer, lymphoma
other malignancies: metastatic seminoma, Kaposi’s sarcoma, breast cancer
aortic aneurysm
mediastinal fibrosis
goitre
SVC thrombosis
SVCO Management
general: O2 if required, dexamethasone, balloon venoplasty, stenting
small cell: chemotherapy + radiotherapy
non-small cell: radiotherapy
Lynch Syndrome
Autosomal dominant
Develop colonic cancer and endometrial cancer at young age
80% of affected individuals will get colonic and/ or endometrial cancer
High risk individuals may be identified using the Amsterdam criteria
How to work out the breakthrough dose of morphine
= 1/6th of daily morphine dose
Palliative care Mx of hiccups
chlorpromazine or haloperidol
gabapentin and dexamethasone also used
Mx of excessive respiratory secretions
hyoscine hydrobromide
Mx of bowel colic
hyoscine butylbromide
HPV subtypes
Subtypes 16,18 & 33 are particularly carcinogenic.
6 & 11 are non-carcinogenic and associated with genital warts.
preferred opiates in CKD
Alfentanil, buprenorphine and fentanyl
raised calcitonin suggests what type of cancer?
medullary thyroid cancer
Most common tumour causing bone metastases (in descending order)
prostate
breast
lung
Mx of metastatic bone pain
analgesia, bisphosphonates or radiotherapy
