Palliative + Oncology Flashcards
intracranial causes of nausea and vomiting - management
cyclizine
gastro-intestinal pain in palliative care.
domperidone
acute migraine, chemotherapy or radiotherapy-induced nausea and vomiting. It is a prokinetic agent which is unlikely to provide relief from nausea related to increased intracranial pressure.
metoclopramide
chemotherapy antiemetic
ondanstetron
Li-Fraumeni Syndrome
what gene? (1)
what cancers? (2)
p53 tumour suppressor gene
sarcomas leukaemia
BRAC 1 and 2 - what genes? 92)
which cancers? (3)
chromosome 17 (BRCA 1) and 13 (BRCA 2)
ovarian cancer
breast cancer
prostate cancer
Lynch syndrome:
how inherited? (1)
what type of cancer (2)
autosomal dominant
colon and endometrial cancer
What is the Amsterdam criteria? (1)
Used to identify Lunch
Three or more family members with a confirmed diagnosis of colorectal cancer, one of whom is a first degree (parent, child, sibling) relative of the other two.
Two successive affected generations.
One or more colon cancers diagnosed under age 50 years.
Familial adenomatous polyposis (FAP) has been excluded.
gardeners syndrome
Autosomal dominant familial colorectal polyposis
Multiple colonic polyps
Extra colonic diseases include: skull osteoma, thyroid cancer and epidermoid cysts
Desmoid tumours are seen in 15%
Mutation of APC gene located on chromosome 5
Due to colonic polyps most patients will undergo colectomy to reduce risk of colorectal cancer
Now considered a variant of familial adenomatous polyposis coli
Adverse effects of chemotherapy:
Bleomycin? (1)
lung fibrosis
Adverse effects of chemotherapy:
anthracyclines (doxorubicin)
cardiomyopathy
Adverse effects of chemotherapy: methotrexate
myelosuppression, mucositis, liver fibrosis, lung fibrosis
Adverse effects of chemotherapy: cisplatin
nephrotoxicity, ototoxicity, peripheral neuropathy, hypomagnaesia
Hiccups in palliative care management
- chlorpromazine or haloperidol
gabapentin
dexamethasone is also used, particularly if there are hepatic lesions
palliative care: agitation/ confusion mangement
Underlying causes of confusion need to be looked for and treated as appropriate, for example hypercalcaemia, infection, urinary retention and medication. If specific treatments fail then the following may be tried:
first choice: haloperidol
other options: chlorpromazine, levomepromazine
oral–> SC morphine conversion
Divide by two for oral to subcutaneous morphine conversion
breakthrough morphine
1/6th total
Raised beta-human chorionic gonadotropin with a raised alpha-feto protein level
The correct answer is: Non-seminomatous testicular cancer
Palliative analgesia and renal failure:
- mild/moderate
- severe?
oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred
what analgesia works for metastatic bone pain? (3)
opioids
bisphosphonates
radiotherapy
How much to increase opioid dose by?
30-50%
codeine to morphine
divide by 10
Treatment Alzheimers:
1st line? (1)
2nd line?
1st= acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)
2nd= memantine (an NMDA receptor antagonist) - used in severe disease
Donepezil:
when contraindicated? (2)
BRADYCARDIA
adverse events including insomnia
Delerium:
management in Parkinsons
management can be challenging in patients with Parkinson’s disease, as antipsychotics can often worsen Parkinsonian symptoms
careful reduction of the Parkinson medication may be helpful
if symptoms require urgent treatment then the atypical antipsychotics quetiapine and clozapine are preferred
Addenbrooks Cognitive Exam- cut off for dementia
82
MMSE score - dementia cut off
24/30
Dementia blood screen (5)
second test (1)
- FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels.
- neuroimaging is performed* to exclude other reversible conditions (e.g. Subdural haematoma, normal pressure hydrocephalus)
STOPP drugs in elderly
CNS and Psychotropic Drugs:
Long-term benzodiazepines in older adults prone to falls.
Anticholinergics –> with cognitive impairment.
Cardiovascular Drugs:
Beta-blockers –> in diabetes mellitus and frequent hypoglycemia.
Loop diuretics –> dependent ankle edema without heart failure.
Gastrointestinal Drugs:
Proton pump inhibitors for peptic ulcers at full therapeutic dose >8 weeks.
Musculoskeletal Drugs:
NSAIDs in patients with moderate-to-severe hypertension or chronic kidney disease.
Endocrine Drugs:
Sulfonylureas with a long duration of action in patients with a history of hypoglycemia.
TCA in dementia –> worsening cognitive impairment
Dementia + fluctuating cognition
Lew body dementia
medications for LBD
both acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine can be used as they are in Alzheimer’s.
Vascular dementia:
treatment
Only consider AChE inhibitors or memantine for people with vascular dementia if they have suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies.
NOT aspirin unless for other cause
Semantic dementia features
Here the patient has a fluent progressive aphasia. The speech is fluent but empty and conveys little meaning. Unlike in Alzheimer’s memory is better for recent rather than remote events.
Vincristine causes what Sx
peripheral neuropathy
Calcitonin is a tumour marker in
medullary thyroid cancer ( it originates from the parafollicular cells, which produce calcitonin.)
Which cancer is last likely to be inherited? colorectal OR gastric?
GASTRIC is not very inheritable
Raised beta-human chorionic gonadotropin with a raised alpha-feto protein level
Non-seminomatous testicular cancer
