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Cancer Care Block > Pharmacology in Cancer Care > Flashcards

Pharmacology in Cancer Care Flashcards

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1
Q

Which chemotherapy agent is most associated with cardiomyopathies?

A

Doxorubicin

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2
Q

What drug can be used in bowel colic caused by obstruction?

A

Hyoscine butylbromide

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3
Q

How does hyoscine butylbromide work?

A

Anti-cholinergic which:

1) Reduces secretions into the bowel
2) Relaxes smooth muscle/prevents smooth muscle spasms

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4
Q

What is Hyoscine butylbromide also known as? (brand name)

A

Buscopan

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5
Q

What is Hyoscine butylbrominde indicated in aside from bowel obstruction in palliative care?

A

IBS

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6
Q

What drug can be used to reduce respiratory secretions in palliative care?

A

Hyoscine hydrobromide

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7
Q

What does Hyoscine hydrobromide do?

A

Reduce respiratory secretions

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8
Q

In agitation and confusion (of irreversible cause), what can we use first line?

A

Haloperidol

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9
Q

What can we use to treat agitation and restlessness with in the terminal stages of illness?

A

Midazolam

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10
Q

What side effect is most associated with cisplatin?

A

Hypomagnesaemia

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11
Q

What side effects are most associated with methotrexate?

A

Myelosuppression
Liver fibrosis
Oral mucositis

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12
Q

If a patient has CKD/impaired renal function, what opioids c.are best to use?

A

Buprenorphine
Alfentanil
Fentanyl

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13
Q

How should you convert from oral morphine total daily dose to diamorphone/syringe driver dose?

A

Divide total daily dose by three.

E.g. 60mg BD of MST -> 40mg total daily dose diamorphine in syringe driver

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14
Q

What is the appropriate PRN dose of oramorph based on daily dose of morphine?

A

1/6

E.g. if someone takes 120mg oramorph total in a day, 20mg is the right PRN dose

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15
Q

What can we give in SVC obstruction when a pt has RICP?

A

Dexamethasone (more effective than mannitol in this situation)

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16
Q

With intracranial tumours, what do we trial to improve symptoms of N and V?

A

Dexamethasone

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17
Q

What cytotoxic agent causes lung fibrosis?

A

Bleomycin

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18
Q

What cytotoxic agent causes haemorrhagic cystitis?

A

Cyclophosphomide

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19
Q

Which cytotoxic agent causes peripheral neuropathy when used to treat lymphoma?

A

Vincristine

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20
Q

Describe the chemo man to me :) Draw him out.

A

Image used to remember common chemotoxicities.

B for bleomycin -> lungs -> pulmonary fibrosis.
C for cysplatin/carboplatin -> ears and kidneys -> nephrotoxic and acoustic nerve damage.
Cy for cyclophosphamide -> bladder/urethra -> haemorrhagic cystitis.
D for doxorubicin -> cardiotoxic/cardiomyopathies.
M,5,6 for MTX, 5FU, and 6-MP -> legs (inside) -> myelosuppression.
V for vincristine -> legs and arms -> peripheral neuropathy

Puffy face for decadron

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21
Q

What can we give for hiccups in palliative care?

A

Chlorpromazine or haloperidol

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22
Q

Where can you study chemotherapy agents in more detail?

A

My CPT Chemotherapy Deck!

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23
Q

What is it important to remember about certain drugs like morphine and buprenorphine?

A

They are controlled drugs so they have to be prescribed in a certain way!

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24
Q

How should controlled prescriptions be signed?

Study These Flashcards
A 
In ink (indelible)
By the prescriber
Including the date they were signed and have prescribing address on them.
25
What patient details must a controlled prescription have?
Name and address. | Cannot use PO Box.
26
For controlled drugs, what needs to be written on the prescription about the preparation of the drug?
- The form i.e. tablets, capsule, suspension. | - The strength of preparation (if more than one available)
27
If a liquid controlled drug is prescribed, what do we need to include on the form?
Total volume to be supplied in numbers and letters.
28
If a tablet/capsule controlled drug is prescribed, what do we need to include on the form?
The total number of capsules in letters and numbers.
29
What happens if a controlled drug prescription is not filled out correctly?
"A pharmacist is not allowed to dispense a Controlled Drug unless all the information required by law is given on the prescription." -NICE Guidelines
30
Where can I look at a nice example of a controlled drug prescription?
https://bnf.nice.org.uk/guidance/controlled-drugs-and-drug-dependence.html
31
What types of pain respond poorly or only partially to opioids?
Bone (partial) and Neuropathic (poor)
32
Where does tramadol come on the WHO pain ladder?
Step 2
33
What adjuvants can we use with analgesia for bony pain?
Bisphosphonates
34
What are the common side effects associated with opioids?
- Constipation - Dry Mouth - N&V - Drowsiness/sedation
35
If a patient is nervous about using opioids, what might be on their mind?
- Addiction - The end of the road - Last resort/is there anything if this doesn't work? - Side effects
36
What do we write up with analgesia?
PRN/regular laxative and antiemetic | PPI if NSAID
37
What dose should we start a pt on for analgesia?
A low dose, then titrate up slowly. | Have an appropriate PRN dose available
38
If regular paracetamol isn't helping, what is an appropriate escalation to make?
Tramadol OR Co-codamol 30/500
39
If we need to escalate from tramadol, what would be an appropriate drug?
Morphine PO
40
If a pt is struggling to swallow on PO analgesia, or develops GI side effects e.g. viral gastroenteritis, what can we switch them to?
S/C Morphine
41
What is the conversion rate between Codeine and Morphine?
Codeine:Morphine = 1:1 e.g. 240mg codeine = 24mg morphine
42
If a patient is on 240mg of codeine and we need to escalate, what should we do?
240mg is max dose of codeine. 240/10 = 24mg of morphine. To escalate - round up to 30mg of morphine per day. Prescription: Morphine SR 15mg BD + Morphine IR 5mg PRN OR Morphine IR 5mg 4 hourly + Morphine IR 5mg PRN
43
How is the PRN dose of morphine calculated?
1/6 of total daily dose
44
What are IR and SR morphines?
Immediate release and slow release
45
When escalating from one dose of morphine to another, how do we calculate what it should go up to?
Work out new daily total from regular doses + all PRN doses taken for NEW TOTAL DAILY DOSE. Divide this by 2 for new BD dose. Divide total by 6 for new PRN dose.
46
What are the immediate release forms of oral morphine?
Oramorph (liquid) | Sevredol (tablets)
47
What are the slow release forms of oral morphine?
Zomorph (capsules) | MST (tablets)
48
What are the cautions needed with opioid analgesics?
Side effects Toxicity Renal function Check it works at all before increasing dose.
49
How do we work out the PRN for S/C analgesia i.e. syringe driver analgesia?
The same as with oral - 1/6 of total daily dose given S/C
50
How do we change from oral morphine to S/C morphine e.g. if the patient is no longer able to swallow?
Ratio is 2:1 Oral:SC so divide the total daily oral dose by 2 for new S/C total daily dose. e.g. 10mg TDD oral -> 5mg/24 hours by infusion
51
What is the conversion rate from oral morphine to S/C diamorphine?
3:1 | 30mg oral morphine -> 10mg S/C diamorphine
52
What is the conversion rate from oral morphine to oral oxycodone?
2:1 | 20mg oral morphine -> 10mg oral oxycodone
53
What is the conversion rate from oral oxycodone to S/C oxycodone?
2:1 | 20mg oral oxycodone -> 10mg S/C oxycodone
54
What patch can we give for pain relief?
Fentanyl patch!
55
If someone has 90mg of oral morphine over 24 hours, how many fentanyl patches does that equate to?
A 25mcg/hr fentanyl patch
56
What are the kinds of immunotherapy?
``` Monoclonal antibodies Checkpoint inhibitors Treatment vaccines Cytokines BCG ```
57
How do immunotherapies help treat cancer?
They either mark the cancer cells so they are more visible to the immune system, or boost the immune systems ability to work against the cancer.
58
What are the most common reactions to immunotherapy?
Skin reactions at the needle site e.g. pain, swelling, itching, rash, redness
59
Other than injection site reactions, how can the body react to immunotherapy?
Flu-like symptoms (fever/weakness/dizzines/N+V/muscle ach/headache/SoB)

Cancer Care Block (10 decks)

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