Oncology and Palliative Medicine

Question 1

Anti-emetic of choice when the cause of nausea and vomiting is metabolic in nature? (ureamia, hypercalcaemia)

Answer 1

Metabolic causes of nausea and vomiting (e.g. hypercalcaemia) are particularly sensitive to central dopamine antagonists such as levomepromazine.

Question 2

Anti-emetic of choice for preventing the delayed phase of cehmotherapy induced emesis?

Answer 2

Dexamethasone has been shown by numerous trials to be the most effective agent in preventing delayed nausea and vomiting. As opposed to more immediate nausea and vomiting, for which antiemetics are useful, the delayed reaction (between 24 hours and 1-week post-chemotherapy) is not as effectively reduced by antiemetics.

Question 3

In the terminal phase of the illness then agitation or restlessness best pharmacological agent?

Answer 3

Midazolam.

Question 4

Management for intractable hiccups?

Answer 4

1. Chlorpromazine is licensed for the treatment of intractable hiccups.
2. Haloperidol, gabapentin are also used.
3. Dexamethasone is also used, particularly if there are hepatic lesions.

Question 5

Adverse effects of cyclophosphamide?

Answer 5

1. Haemorrhagic cystitis: incidence reduced by the use of hydration and mesna
2. Myelosuppression
3. Transitional cell carcinoma

Question 6

Tx for radiotherapy induced mucositis?

Answer 6

Benzydamine mouthwash.

Question 7

Which cytotoxic agent causes peripheral neuropathy?

Answer 7

Vincristine.

Question 8

Cytotoxic agent that causes cardiomyopathy?

Answer 8

Doxorubicin.

Question 9

Choice of opioid in patients with severe renal impairment?

Answer 9

Fentanyl is preferred.

(Alfentanil, buprenorphine also recommended)