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Finals > Palliative care > Flashcards

Palliative care Flashcards

1
Q

Pre-emptive prescribing - 5 core symptoms to prescribe for

A 
Pain - Morphine
Breathlessness - morphine PRN
Agitation - Midazolam
Secretions - hyoscine butybromide
Nausea - Haloperidol
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2
Q

Syringe driver ratio

A

injectable is 2x strength of oral opioids so give half

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3
Q

Opioid SE

A

nausea, constipation, drowsiness, dry mouth

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4
Q

Adjuvant analgesics

A

For neuropathic pain – amitriptyline, pregabalin, gabapentin

Muscle spasms – baclofen, clonazepam, diazepam

Compression symptoms – dexamethasone

Bone pain – zolendronic acid

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5
Q

Oncology emergency - spinal compression mx

A

Neurosurgery - MRI whole spine

IV Dex and VTE prophylaxis

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6
Q

Neutropenic sepsis ivx

A

FBC, LFT, U+E, CRP, clotting, lactate, glucose
Blood cultures, venous blood gas
Urine culture
Swab/culture central line

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7
Q

Neutropenic sepsis mx

A

Sepsis 6

Tazocin 4.5g IV TDS

Can give granulocyte colony stimulating factor - Filgrastim

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8
Q

Neutropenic sepsis mx viral/fungal

A

Aciclovir, Fluconazole

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9
Q

Hypercalcaemia of malignancy

A

parathyroid hormone related peptide secretion by tumour

Osteoblast suppression, osteoclast activation

Calcitriol production in lymphoma

Ectopic hyperparathyroidism in SCLC

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10
Q

Symptoms of hypercalcaemia

A

Dehydration and - Bones, Stone, groans, thrones and psychic moans

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11
Q

Hypercalcaemia management

A

Hydration
Malignancy therapy
U+E monitoring

If severe - IV Bis/denosumab
Furosemide

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12
Q

Hypercalcaemia ivx

A

Total calcium elevated, corrected calcium >2.6
Urgent if over 3

Check ECG (may have short QT)

PTH elevated if ectopic, serum PTHrP elevated if humoral, calcitriol high in lymphoma

Skeletal XRs if not known metastases

CXR – lung Ca, sarcoidosis

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13
Q

Superior vena cava obstruction mechanisms

A

intraluminal obstruction or extrinsic compression, or a thrombus

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14
Q

Superior vena cava obstruction symptoms

A

Oedema of face and upper limbs, dyspnoea, venous engorgement (facial plethora, neck and chest), cough, hoarse voice

Venous engorgement worse leaning forward

Fixed non pulsatile raised JVP

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15
Q

Superior vena cava obstruction ix

A

Do CXR for lung mass, CT thorax with contrast for collateral vessels and location, and USS upper extremities (for dilation SVC, thrombi)

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16
Q

Superior vena cava obstruction mx

A

Dex
Radiotherapy
Malignancy treatment

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17
Q

Tumour lysis syndrome cause

A

Metabolic and electrolyte abnormalities and renal impairment

Usually hours/days into chemotherapy
Usually chemosensitive lymphoma/leukaemia

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18
Q

Tumour lysis syndrome electrolytes

A

Hyperuricaemia – can cause uric acid nephropathy and AKI

Hyperphosphataemia – can cause calcium phosphate deposition and obstruction

Secondary hypocalcaemia (from high phosphate)

Hyperkalaemia (from cell degradation)

19
Q

Tumour lysis syndrome presentation

A

Syncope/chest pain/dyspnoea
Seizures
Nausea, D+V
Muscle weakness and cramps

25% INCREASE in uric acid, phosphate, potassium
25% DECREASE in calcium
High creatinine and LDH

20
Q

Tumour lysis syndrome mx

A

Prevention is key

Prechemotherapy IV fluids, avoid nephrotoxic meds, use allopurinol (blocks conversion to uric acid)

Treating – hydrate, correct high potassium, give rasburicase (oxidises uric acid), give aluminium hydroxide (phosphate binder)

21
Q

Cheyne-Stokes breathing

A

rapid breaths followed by apnoea

22
Q

Anti-emetics

A

Bowels
Domperidone – D2 antagonist
Hyoscine butylbromide - antimuscarinic

Brain and bowels
Ondansetron – 5HT3 antagonist
Metoclopramide – D2 antagonist

Brain
Cyclizine – H2 antagonist
Prochlorperazine

Biochemistry and brain
Haloperidol – D2 antagonist
Levopromazine – D2, H2, 5HT3 antagonist

23
Q

NSCLC paraneoplastic syndromes

A

Hypercalcaemia, and occasionally Cushing’s syndrome

24
Q

Carcinoid syndrome

A

mainly gastric carcinoma, also bronchial or pancreatic

Flushing, wheeze, abdo pain

treat with resection, octreotide (somatostatin analogue)

25
Q

Aggressive sarcomas

A

angiosarcoma (long term bruising at breast) and Ewing’s sarcoma (bone sarcoma young males)

26
Q

Lymphoedema

A

Lymphatic stasis and loss of thoracic duct return

thickened skin, honeycombing of fluid and fibrous tissue

Blood smear may show parasite filariasis

27
Q

filiariasis tx

A

diethylcarbamazine

28
Q

Pancreatic cancer blood test monitoring

A

CA 19-9

29
Q

Ovarian cancer tumour marker

A

CA 125

30
Q

Breast cancer tumour marker

A

CA 15-3

31
Q

Colorectal cancer marker

A

Carcinoembryonic antigen (CEA)

32
Q

Hepatocellular carcinoma, teratoma marker

A

Alpha-feto protein (AFP)

33
Q

Melanoma, schwannomas marker

A

S-100

34
Q

Small cell lung carcinoma, gastric cancer, neuroblastoma marker

A

Bombesin

35
Q

Reducing mouth pain

A

Benzydamine hydrochloride mouthwash

36
Q

Bowel colic relief

A

hyoscine hydrobromide,

37
Q

Confusion management in palliative prescribing

A

first choice: haloperidol

other options: chlorpromazine, levomepromazine

38
Q

HPVs associated with cervical cancer

A

16,18,33

39
Q

Cancer drug with peripheral neuropathy

A

Vincristine

40
Q

Cancer drug with cardiac hypertrophy

A

Doxorubicin

41
Q

Lung fibrosis cytotoxic

A

Bleomycin

42
Q

Calcitonin marker of?

A

Medullary thyroid cancer

43
Q

Hiccup management

A

chlorpromazine or haloperidol

Finals (18 decks)

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