Palliative, Oncology, Geris, Immunology Flashcards
Confusion in palliative care first line Rx (3)
Haloperidol
Chlorpromazine
Levomepromazine
Agitations or restlessness in palliative care (1)
Midazolam
Hiccups in palliative care (4)
Chlorpromazine - intractable hiccups
Haloperidol, gabapentin
Dexamethasone
Opiates in palliative care prescribing:
Initialy prescribing
Breakthrough pain
Increasing
20-30mg MR (15mg MR BD) with 5mg IR breakthrough pain
With laxatives
Increase by 30-50%
What should the breakthrough dose of morphine be?
One sixth the daily dose of morphine
What to give instead of morphine if there is mild to moderate renal impairment? (1)
Severe renal impairment? (3)
Oxycodone
Alfentanil, buprenorphine, fentanyl
Morphine to oxycodone =
PO morphine to SC morphine
Divide by 1.5
Divide by 2
Medications in palliative care:
Nausea and vomiting (4)
Secretions (3)
Agitation (3)
Pain (1)
Cyclizine, levomepromazine, haloperidol, metoclopramide
Secretions: hyoscine hydrobromide, butylbromide, glycopuronium bromide
Agitations: midaz, haloperidol, levomepromazine
Pain diamorphine
PO morphine to SC diamorphine
Divide by 3
N&V in palliative care mx
Reduced gastric motility (opioid related) (2)
Metoclopramide
Domperidone
N&V in palliative care mx
Raised ICP (cerebral mets) (2)
Cyclizine
Dexamethasone
N&V in palliative care mx
Chemically mediated (hypercalcaemia, chemo) (3)
Ondansetron
Haloperidol
Levomepromazine
N&V in palliative care mx
Visceral (due to constipation) (2)
Cyclizine + levomepromazine
N&V in palliative care mx
Vestibular (1)
Cyclizine
N&V in palliative care mx
Corticol (anxiety, pain, fear)
Loraz
Mild - moderate Alzheimer’s disease mx (3) MOA
Second line treatment (1) MOA
Donepezil
Galantamine
Rivastigmine
Acetylcholinesterase inhibitors
Memantine
NMDA receptor antagonist
Donepezil CI (1) and adverse effect (1)
Bradycardia
Insomnia
Assessment tools for dementia recommended by NICE
10 point cognitive screener
6 item cognitive impairment test
What is Pick’s disease?
Age of onset
Frontotemperal dementia
Progressive non fluent aphasia
<65yo
personality change and impaired social conduct. Other common features include hyperorality, disinhibition, increased appetite, and perseveration behaviours =
Pick’s disease/ frontotemperal dementia
Focal gyral atrophy with a knife-blade appearance = which type of dementia?
= Picks
Alzheimer’s vs Lew body dementia vs Pick’s
AD - early impairments in attention and executive function
LBD - cognitive impairment
Picks - personality changes, progressive aphasia
Patient who has deteriorated following the introduction of an antipsychotic agent =
Lewy body dementia
Lewy body dementia features (3)
Visual hallucination
Progressive cognitive impairment
Parkinsonism
Waterlow score is used to screen patient who are at risk of developing…
Classification
Pressure areas
1 erythema of intact skin
2 partial thickness skin loss
3 full thickness skin loss
4 extensive destruction
Types of allergy tests (3)
What are they useful for?
Skin prick - most common, food and pollen
RAST - food and pollen, used instead of skin tests e.g in severe eczema
Skin patch - contact dermatitis
Adrenaline doses in anaphylaxis
<6 month
6months-6 years
6-12 years
>12 years
How often can adrenaline be repeated?
Location
<6 month - 100-150mcg
6months-6 years 150mcg
6-12 years 300 mcg
>13 years 500 mcg
1 in 1000
Every 5 mins
Location anterolateral aspect of the middle third of the thigh
Mx following stabilisation of allergy: - 4
Non sedating oral antihistamines
Serum tryptase levels
Specialist allergy clinic referral
Adrenaline injector as interim measure (x2 injections)
Discharge following anaphylaxis (3)
Fast track discharge (<2 hours) single dose adrenaline
Minimum 6 hours 2 doses of adrenaline
Minimum 12 hours - >2 doses of adrenaline
What is oral allergy syndrome?
pollen-food allergy, is an IgE-mediated hypersensitivity reaction to specific raw, plant-based foods including fruits, vegetables, nuts and certain spices
Most common tumour causing bone metastases (3)
Most common cancers in the UK (3)
Most common causes of death from cancer in the UK (3)
Prostate, breast, lung
Breast, lung, bowel
Lung, bowel, breast
Chemo N&V 1st line mx
Low risk
High risk (2)
Low risk metoclopramide
High risk ondansetron +/- dexamethasone
RF for development of N&V with chemo (4)
Anxiety
<50yo
Concurrent opioid use
Type of chemo
Adverse effects of cyclophosphamide (3)
Haemorrhagic cystitis
Myelosuppression
Transitional cell carincoma
Mx neoplastic spinal cord compression
High dose oral dexamethasone
Oncology assessment
Superior vena cava obstruction is most commonly associated with which cancer?
Lung
dyspnoea
swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
headache: often worse in the mornings
visual disturbance
pulseless jugular venous distension =
Superior vena cava obstruction
Ca 15-3
Breast ca
S-100 tumour antigen =
Melanoma
