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Finals > Palliative and Onc > Flashcards

Palliative and Onc Flashcards

1
Q

3 types of pain and use of opiods

A

Acute- limited duration with obvious cause. Start high then taper off
Chronic- no physiological cause anymore. Avoid at all costs
Cancer and end of life. Start low and slowly titrate

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2
Q

Pain relief for solid tumour

A

Use opioids

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3
Q

Management of neuropathic pain in cancer

A

Opioids semi work
Add co analgesiac such as pregabalin and gabapentin

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4
Q

Management of bone pain in cancer

A

Strong opioid and bisphosphonate
Radiotherapy- most effective, specific tx although does make pain worse initially

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5
Q

Management of nerve compressoin from cancer

A

Opioid and steroid

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6
Q

Liver capsule pain in cancer maangement

A

Opioid with one of NSAID or dexamethasone

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7
Q

Muscle pain/spasm in cancer

A

Muscle relaxant

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8
Q

What are the weak opiods

A

Codeine
Dihydrocodeine
Tramadol
Buprenorphine

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9
Q

What are strong opioids

A

Oxycodone
Moprhine
Alfentanil
Diamorphine

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10
Q

First line opioid used

A

Morphine

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11
Q

Management of side effects of opioids
- nausea
- drowsiness
- constipation

A

Nausea- usually resolves or anti emetic
Drowsiness- reduce dose or resolves
Constipation- stimulant laxative

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12
Q

What class of chemo causes dilated cardiomyopathy

A

Anthracycline

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13
Q

If suspect neoplastic chord compression, what give and so ASAP

A

High dose dexamethasone
Referral for MRI of whole spine in 24 hours

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14
Q

What is gardners syndrome

A

Autosomal dominant FAP with extra colonic tumours- bone and thyroid

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15
Q

Best anti-emetic if undergoing chemo and radiotherapy

A

5HT3 antagonist like ondensatron

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16
Q

Management of superior vena cava obstruction

A

Glucocorticoids initially
Endovascular stenting best option often

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17
Q

What is best management option for superior vena cava obstruction

A

Endovascular stenting

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18
Q

Most common site of bony mets

A

Spine

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19
Q

How do PET scans work

A

Glucose uptake

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20
Q

What anti-emetic use to treat nausea from intracranial tumours

A

Cyclizine first line then dexamethasone

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21
Q

Earliest and most common symptoms of neoplastic spinal chord compression

A

Back pain

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22
Q

What use to monitor teratoma treatment

A

AFP
B HCG

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23
Q

Presentation of vena cava obstruction

A

Visual problems
SOB- most commonly
Swelling of face
Headaches
JVP distention that is pulseless

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24
Q

What chemo agent most likely to cause hypomagnaesaemia

A

Cisplatin

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25
Q

What chemo agent most likely to cause lung fibrosis

A

Bleomycin

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26
Q

What chemo agent most likely to cause haemorrhagic cystitis

A

Cyclophosphamide

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27
Q

What chemo agent most likely to cause peripheral neuropathy

A

Vincristine

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28
Q

Side effects of methotrexate as a chemo

A

Mucositis
Myelosuppression
Liver fibrosis

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29
Q

General side effects of chemo agents

A

Nausea and vomiting
Myelosuppression
Lung fibrosis
Cardiomyopathy

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30
Q

Other than breast cancer, what does BRCA2 increase risk of

A

Prostate

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31
Q

How investigate metastatic disease of unknown primary

A

FBC, U&E, LFT, calcium, urinalysis, LDH
Chest X-ray
CT of chest, abdomen and pelvis
AFP and hCG

32
Q

Cancer marker for breast

A

CA 15-3

33
Q

What can be marker of large cell lung cancer

A

bHCG

34
Q

Which subtypes of HPV lead to cervical cancer

A

16, 18 and 33

35
Q

Medications used for secretions in palliative care

A

Hyoscine
Glycopyrronium bromide
Bucospan

36
Q

What can be done to reduce secretions in palliative care

A

Avoiding fluid overload- manage fluids given
Medications- hyoscine or glycopyrronium bromide

37
Q

Anti-emetic for intracranial pressure

A

Cyclizine (1st choice) or dexamethasone

38
Q

First line anti-emetic for vestibular problems

A

Cyclizine

39
Q

Anti-emetic options for vestibular problems

A

1st line- cyclizine
2nd- prochlorperazine

40
Q

Management of chemical mediated N&V

A

Treat underlying cause like hypercalcaemia if possible
Ondensatron and metoclopramide are options

41
Q

How manage bowel colic in palliative care

A

Add hyoscine or glycopyrronium to syrine driver

42
Q

If renal impairment severe what give for palliative pain relief

A

Buprenorphine or fentanyl

43
Q

If is mild-moderate renal impairment what give for palliative care pain relief

A

Oxycodone

44
Q

What anti-emetic give for gastroparesis

A

Metoclopramide

45
Q

Gastroparesis in palliative care presentation

A

Nausea
Constipated however passing wind
Early satiety

46
Q

Patient who underwent radiotherapy for mouth cancer now has painful ulcers everywhere

A

Mucositis secondary to radiotherapy

47
Q

What may be used for a painful mouth at end of life

A

Benzydamine hydrochloride mouthwash

48
Q

How manage hiccups at end of life

A

Chlorpromazine
Haloperidol

49
Q

Presentation of opiate overdose in palliative patient

A

Resp depression
Low GCS
Myoclonic jerks
Pinpoint pupils

50
Q

How manage confusion in palliative patient

A

Screen for other causes- infection, retention, medication etc
First line- haloperidol
If in terminal stage then subcut midazolam

51
Q

What drug use first line for confusion in palliative patient

A

Haloperidol

52
Q

When can use midazolam for confusion in palliative patient

A

If in terminal phase

53
Q

RFx for pressure ulcers

A

Malnourishment
Pain
Immobile

54
Q

Management of pressures sores

A

Create moist environment- hydrocolloid dressing
Analgesia
Nutritional assesment

55
Q

When use abx for pressure sores

A

Only if evidence of surrounding cellulits or underlying osteomyelitis

56
Q

Who can consider referral to for pressure sores

A

Surgeons to debride
Tissue viabiliy nurse

57
Q

What use for headache from tumour ICP

A

Opioid plus dexamethasone

58
Q

When use oxycodone for pain in renal impairment

A

eGFR 20-40

59
Q

When use alftentanyl for pain relief

A

eGFR under 10

60
Q

MOA of prochloperazine etc

A

Phenothiazine- dopamine antagonist

61
Q

Chemical causes of nausea and vomiting

A

Biochemical- uraemia and hypercalcaemia
Drugs- chemo, opioids

62
Q

Best chemical mediated nausea and vomiting anti-emetic if palliative

A

Haloperidol

63
Q

Post op nausea and vomiting anti emetic

A

Ondensatron

64
Q

Managing SOB in palliative care

A

Consider if hypoxaemic or not
- then oxygen
If feel breathless with no hypoxia
- oral immediate release low dose opioid 1st or if does not work short acting benzo
If anxiety component
- short acting benzo
If wheeze from partial obstruction
- bronchodilator while awaiting stent/radiotherapy

65
Q

What use for SOB at end of life

A

Midazolam

66
Q

How manage constipation from opioids in palliative patients

A

Give senna alongside- do not wait to treat constipation if develops

67
Q

Ladder for constipation in palliative care

A
  1. Senna
  2. Add osmotic laxative or surface softener
  3. Suppository
  4. Phosphate enemas as last resort- really try to avoid
68
Q

What are classes of laxatives and their MOA

A

Stool softener- lubricates to make softer
Stimulant- increases peristalsis
Bulk forming- adds weight to faeces which stimulates peristalsis
Osmotic- draws water in which makes softer

69
Q

MOA of lactulose

A

Osmotic agent

70
Q

MOA of docusate

A

Stimulant and soften stool

71
Q

MOA of movicol

A

Osmotic agent

72
Q

MOA of fybogel

A

Bulking agent

73
Q

When increasing morphine in sub cut infuser, how much do by

A

30-50%

74
Q

What is empirical anti emetic cause if no clear cause identifiable in palliative patients

A

Metoclopramide

75
Q

What are visceral/serosal causes of nausea

A

Bowel obstruction
Constipation

76
Q

Management of nausea and vomiting from constipation in palliative patients

A

Cyclizine

Finals (29 decks)

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