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Cancer Care Block > Pharmacology in Cancer Care > Flashcards

Pharmacology in Cancer Care Flashcards

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?

A 
In ink (indelible)
By the prescriber
Including the date they were signed and have prescribing address on them.
25
Q

What patient details must a controlled prescription have?

A

Name and address.

Cannot use PO Box.

26
Q

For controlled drugs, what needs to be written on the prescription about the preparation of the drug?

A
  • The form i.e. tablets, capsule, suspension.

- The strength of preparation (if more than one available)

27
Q

If a liquid controlled drug is prescribed, what do we need to include on the form?

A

Total volume to be supplied in numbers and letters.

28
Q

If a tablet/capsule controlled drug is prescribed, what do we need to include on the form?

A

The total number of capsules in letters and numbers.

29
Q

What happens if a controlled drug prescription is not filled out correctly?

A

“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
Q

Where can I look at a nice example of a controlled drug prescription?

A

https://bnf.nice.org.uk/guidance/controlled-drugs-and-drug-dependence.html

31
Q

What types of pain respond poorly or only partially to opioids?

A

Bone (partial) and Neuropathic (poor)

32
Q

Where does tramadol come on the WHO pain ladder?

A

Step 2

33
Q

What adjuvants can we use with analgesia for bony pain?

A

Bisphosphonates

34
Q

What are the common side effects associated with opioids?

A
  • Constipation
  • Dry Mouth
  • N&V
  • Drowsiness/sedation
35
Q

If a patient is nervous about using opioids, what might be on their mind?

A
  • Addiction
  • The end of the road
  • Last resort/is there anything if this doesn’t work?
  • Side effects
36
Q

What do we write up with analgesia?

A

PRN/regular laxative and antiemetic

PPI if NSAID

37
Q

What dose should we start a pt on for analgesia?

A

A low dose, then titrate up slowly.

Have an appropriate PRN dose available

38
Q

If regular paracetamol isn’t helping, what is an appropriate escalation to make?

A

Tramadol
OR
Co-codamol 30/500

39
Q

If we need to escalate from tramadol, what would be an appropriate drug?

A

Morphine PO

40
Q

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?

A

S/C Morphine

41
Q

What is the conversion rate between Codeine and Morphine?

A

Codeine:Morphine = 1:1

e.g. 240mg codeine = 24mg morphine

42
Q

If a patient is on 240mg of codeine and we need to escalate, what should we do?

A

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
Q

How is the PRN dose of morphine calculated?

A

1/6 of total daily dose

44
Q

What are IR and SR morphines?

A

Immediate release and slow release

45
Q

When escalating from one dose of morphine to another, how do we calculate what it should go up to?

A

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
Q

What are the immediate release forms of oral morphine?

A

Oramorph (liquid)

Sevredol (tablets)

47
Q

What are the slow release forms of oral morphine?

A

Zomorph (capsules)

MST (tablets)

48
Q

What are the cautions needed with opioid analgesics?

A

Side effects
Toxicity
Renal function
Check it works at all before increasing dose.

49
Q

How do we work out the PRN for S/C analgesia i.e. syringe driver analgesia?

A

The same as with oral - 1/6 of total daily dose given S/C

50
Q

How do we change from oral morphine to S/C morphine e.g. if the patient is no longer able to swallow?

A

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
Q

What is the conversion rate from oral morphine to S/C diamorphine?

A

3:1

30mg oral morphine -> 10mg S/C diamorphine

52
Q

What is the conversion rate from oral morphine to oral oxycodone?

A

2:1

20mg oral morphine -> 10mg oral oxycodone

53
Q

What is the conversion rate from oral oxycodone to S/C oxycodone?

A

2:1

20mg oral oxycodone -> 10mg S/C oxycodone

54
Q

What patch can we give for pain relief?

A

Fentanyl patch!

55
Q

If someone has 90mg of oral morphine over 24 hours, how many fentanyl patches does that equate to?

A

A 25mcg/hr fentanyl patch

56
Q

What are the kinds of immunotherapy?

A 
Monoclonal antibodies
Checkpoint inhibitors
Treatment vaccines
Cytokines
BCG
57
Q

How do immunotherapies help treat cancer?

A

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
Q

What are the most common reactions to immunotherapy?

A

Skin reactions at the needle site e.g. pain, swelling, itching, rash, redness

59
Q

Other than injection site reactions, how can the body react to immunotherapy?

A

Flu-like symptoms (fever/weakness/dizzines/N+V/muscle ach/headache/SoB)

Cancer Care Block (10 decks)

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