palliative Flashcards
CNS antiemitic
cyclicine
B-cell chronic lymphocytic leukemia
monoclonal B cell proliferation. It is the most common adult leukemia
flow citometry
Very high-risk disease: 17p deletion and/or TP53 mutations - chemoimmunotherapy, Single-agent ibrutinib, Ibrutinib plus rituximab until progression (younger patients),
High-risk disease: IGHV unmutated (without 17p deletion and TP53 mutation) - chemoimmunotherapy - Single-agent ibrutinib until progression (all ages)
Ibrutinib plus rituximab until progression (younger patient
RAI Classification
Stage 0: Absolute lymphocytosis of > 10,000/mcL in peripheral blood and >/= 30% lymphocytes in bone marrow
Stage I: Stage 0 plus lymphadenopathy (enlarged lymph nodes)
Stage II: Stage 0 plus hepatomegaly or splenomegaly
Stage III: Stage 0 plus anemia with hemoglobin < 11 g/dL (< 110 g/L) due to bone marrow infiltration of tumor cells.
Stage IV: Stage 0 plus thrombocytopenia with platelet counts <100,000/mcL due to bone marrow infiltration of tumor cells.
oxycodone and morphine
Oxycodone - binding to a receptor, inhibition of adenylyl-cyclase and hyperpolarisation of neurons, and decreased excitability.
Contra - cute respiratory depression; comatose patients; head injury
Morpine -
Horner’s syndrome
docusate sodium
Chronic constipation
Metastatic teratoma
Metastatic teratomas are more common in testicular non-seminomatous germ cell tumors (NSGCTs).
Common in Testicular NSGCTs: Many testicular NSGCTs can present with advanced metastatic disease, including teratomatous elements.
Chemotherapy Resistance: Pure teratomas are typically resistant to chemotherapy.
Burnt-Out Testicular NSGCT: Advanced metastatic disease can be due to the “burnt-out” testicular NSGCT, where the primary tumor is gone, but metastatic lesions remain, including viable NSGCT and teratoma.
Growing Teratoma Syndrome (GTS): Enlargement or recurrence of residual teratoma sites during or after chemotherapy. GTS can be clinically significant due to local complications.
thyroid cancer
85% papilary
10% medullary
pain ladder
Step 1 involves non-opioid analgesics, step 2 utilizes weak opioids, and step 3 employs strong opioids. Step 4, the proposed fourth step, would encompass minimally invasive and invasive techniques.
Here’s a more detailed breakdown:
Step 1: Mild to Moderate Pain:
Non-opioid analgesics like paracetamol, NSAIDs (ibuprofen, naproxen, etc.), and potentially aspirin, are used. Adjuvants (medications that help but are not the primary analgesic) can be added.
Step 2: Moderate Pain:
Weak opioids, such as codeine, dihydrocodeine, or tramadol, are introduced, often in combination with non-opioids and/or adjuvants.
Meptazinol is a centrally acting analgesic, which has demonstrated mixed agonist and antagonist activity at opioid receptors.
Step 3: Severe and Persistent Pain:
Strong opioids like morphine, oxycodone, fentanyl, methadone, etc., are used, potentially with non-opioids and/or adjuvants. The focus here is on finding the right dose and route for pain relief.
clinical trial phases
Phase 1
Purpose: Assess safety, dosage, and side effects in a small group (20–100 healthy volunteers or patients).
Focus: Pharmacokinetics (how the drug is absorbed, metabolized, and excreted).
Duration: Several months.
Phase 2
Purpose: Test efficacy and further evaluate safety in a larger group (100–300 patients with the target condition).
Focus: Optimal dosing and preliminary effectiveness.
Duration: Months to 2 years.
Phase 3
Purpose: Confirm effectiveness, monitor side effects, and compare with standard treatments (1,000–3,000+ patients).
Focus: Statistical significance for regulatory approval.
Duration: 1–4 years.
Phase 4 (Post-Marketing Surveillance)
Purpose: Monitor long-term safety and effectiveness after approval (thousands of patients).
Focus: Rare side effects and real-world use.
Trastuzumab is a targeted cancer drug, specifically a monoclonal antibody, used to treat certain cancers, most notably HER2-positive breast cancer. It works by targeting and blocking the HER2 protein, which can encourage cancer cell growth, thus helping to slow or stop the cancer’s progression
imatinib
CML
GIST
Malignant pericardial effusion
Mechanism: Cancer cells disrupt blood flow or lymphatic drainage around the heart, leading to fluid buildup.
Symptoms: Difficulty breathing, chest pain, fatigue, and lightheadedness are common.
Becks triad
Echocardiography and pericardiocentesis (fluid analysis)
zolindronate
Positive acute-phase proteins
a group of proteins that increase in concentration in the blood during an inflammatory response. These proteins play a crucial role in the body’s defense against infection and injury, assisting in various immune functions like opsonization, complement activation, and pathogen trapping. Examples include C-reactive protein (CRP), serum amyloid A (SAA), haptoglobin, and fibrinogen.
Negative acute phase proteins
a group of proteins whose serum concentrations decrease during the acute phase response, a systemic response to inflammation and infection. Examples include albumin, transthyretin (prealbumin), antithrombin, and transferrin.
Tumor lysis syndrome (TLS)
a potentially life-threatening complication of cancer treatment where rapidly dying cancer cells release their contents into the bloodstream, leading to metabolic and electrolyte imbalances. This can cause serious issues like kidney failure, heart rhythm problems, and seizures.
The rapid release of these substances can lead to high levels of uric acid (hyperuricemia), potassium (hyperkalemia), and phosphate (hyperphosphatemia), as well as low calcium levels (hypocalcemia). xanthenurea
risk factors - leukemia and lymphoma, and those with high white blood cell counts, large tumor burdens, or highly sensitive tumors.
Paraneoplastic Neurologic Disorders
Lambert-Eaton myasthenic syndrome, Lambert-Eaton myasthenic syndrome (LEMS), and paraneoplastic encephalomyelitis are examples of PNS.
Diagnosis can be complex, as it requires ruling out other causes of neurological symptoms, and is often based on a combination of clinical presentation, neurological examinations, serological testing (looking for specific antibodies), and excluding other causes. \
Superior vena cava syndrome (SVCS)
Malignancy is the most common cause of SVC obstruction, accounting for approximately 70% of cases. However, recently the incidence of device related SVC syndrome from central venous catheters and pacemaker or defibrillator leads has been increasing
cancer causes -70%
Non–small cell lung cancer (∼50%)
Small cell lung cancer (∼25%)
Lymphomas (∼10%)
Other cancers including thymoma, primary germ cell neoplasms, mesothelioma, and solid tumors with mediastinal lymph node metastasis (e.g., breast cancer) (∼15%)
other non-cancer causes -30%
Central venous catheters, pacemakers, defibrillator, indwelling hemodialysis catheters (25–30%)
multiple myeloma
Key Diagnostic Criteria:
1. Abnormal Plasma Cells in Bone Marrow:
Clonal Plasma Cells: At least 10% clonal plasma cells in the bone marrow on examination, or a biopsy-proven plasmacytoma.
Bone Marrow Biopsy: A bone marrow biopsy is usually needed to confirm the diagnosis and assess the extent of the disease.
2. Myeloma-Defining Events (MDEs):
At least one of the following:
CRAB Criteria:
Hypercalcemia: Serum calcium greater than 2.75 mmol/L or 1 mg/dL above the upper limit of normal.
Renal Insufficiency: Serum creatinine greater than 177 µmol/L or creatinine clearance less than 40 ml/min.
Anemia: Hemoglobin less than 100 g/L or 20 g/L below the lower limit of normal.
Bone Lesions: One or more osteolytic lesions on imaging studies like X-ray, CT, or PET/CT.
Biomarkers:
Clonal Plasma Cells ≥ 60% in Bone Marrow: This indicates a higher concentration of abnormal plasma cells.
Serum Free Light Chain (FLC) Ratio ≥ 100: This measures the imbalance between kappa and lambda light chains, which can be a sign of myeloma.
Multiple Focal Lesions on MRI: More than one focal lesion on MRI can indicate the presence of myeloma.
Bleomycin
induce pulmonary fibrosis, a condition where scar tissue develops in the lungs. This fibrosis can lead to difficulty breathing and a reduced ability to exchange oxygen and carbon dioxide. The mechanism of bleomycin-induced pulmonary fibrosis involves lung injury, inflammation, and the overproduction of collagen and other matrix components. While there’s no cure for bleomycin-induced pulmonary fibrosis, some treatments, such as corticosteroids, antioxidants, and iron chelators, may be beneficial.
no cure for bleomycin-induced lung fibrosis. Corticosteroids are frequently used to reduce inflammation, but their effectiveness in reversing fibrosis is limited. Other potential treatments include antioxidants, iron chelators, and novel drugs that target the fibrotic process.
MALT lymphoma
mucosa-associated lymphoid tissue lymphoma, is a slow-growing type of non-Hodgkin lymphoma that develops in the lymphatic tissue lining certain organs and cavities. It’s also known as extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. While it can occur in various locations, the stomach is the most common site, often linked to Helicobacter pylori infection.
cT
Gastric MALT Lymphoma:
In the stomach, CT may reveal minimal gastric wall thickening, usually less than 10mm. Infiltrative or polypoid forms can also be seen.
Pulmonary MALT Lymphoma:
Pulmonary MALT lymphoma can present as diverse patterns on CT, including consolidation, masses, or nodules, often with a peribronchovascular distribution.
Head and Neck MALT Lymphoma:
In the head and neck, MALT lymphoma may manifest as a mass in the lacrimal glands or other orbital adnexa.
BTK inhibitors (ibrutinib, zanubrutinib), may be used for recurrent or refractory MALT lymphoma.
morphine
Oral morphine sulfate over 24 hours - 30 mg
Subcutaneous infusion of morphine sulfate over 24 hours - 15 mg
Subcutaneous infusion of diamorphine hydrochloride - 10 mg
over 24 hours Subcutaneous infusion of oxycodone hydrochloride over 24 hours -15 mg
morphine salt 12 mg daily ≡ buprenorphine 5 micrograms/hour transdermal patch
morphine salt 30 mg daily ≡ fentanyl 12 micrograms/hour transdermal patch
bone scan
A small amount of a radioactive tracer (radionuclide) is injected into a vein.
The tracer travels throughout the body and is absorbed by the bones.
Areas with increased bone activity, such as those that are breaking down or being repaired, will show up as “hot spots” on the scan.
These hot spots can indicate conditions like bone cancer, fractures, infections, or other bone-related problems.
