Supportive Therapies and Palliative care

Question 1

Name class of antiemetic: cyclizine

Answer 1

Histamine receptor antagonist

Question 2

Name class of antiemetic: ondansetron

Answer 2

Serotonin (5HT) antagonist

Question 3

Name class of antiemetic: metoclopramide

Answer 3

Dopamide (D2) receptor antagonist

Question 4

Name class of antiemetic: Levomepromazine

Answer 4

Broad spectrum histamine, dopamine and serotonin antagonist

Question 5

Name class of antiemetic: aprepitant

Answer 5

Neurokinin (NK1) antagonism, predominantly responsible for the central mechanism of emesis

Question 6

What are recognised risk factors for chemotherapy induced nausea and vomiting

Answer 6

Female, age <50 years, previous chemo induced nausea and vomiting, hyperemesis, history of anxiety, expectancy of nausea and vomiting, low alcohol intake.

Question 7

Do you need to dose reduce zometa for hypercalcaemia?

Answer 7

Not unless cr >400

Question 8

What would be the first line mangement of itching associated with biliary obstruction?

Answer 8

Colestyramine then ursedeoxycholic acid. Second line options include sertraline, paroxetine and rifampicin.

Question 9

What medication may be helpful in the use of uraemic pruritis?

Answer 9

Gabapentin

Question 10

What electrolyte disturbance is expected in TLS?

Answer 10

High phosphate, high urate, high potassium, high LDH low calcium and often renal impairment.

Question 11

What pharmacological treatments can be used to prevent chemotherapy induced neuropathy?

Answer 11

No proven pharmacological treatments, some evidence for cryotherapy with taxanes.

Question 12

What transferrin saturation level suggests functional iron deficiency?

Answer 12

<20%

Question 13

What pain block is useful for pelvic pain

Answer 13

Superior hypogastric block

Question 14

What pain block is useful for visceral perineal pain

Answer 14

Ganglion impar block

Question 15

What pain block is useful for tumour invasion of peripheral nerve plexus?

Answer 15

Spinal neurolytic block

Question 16

What SAAG is indicative of ascites secondary to peritoneal disease

Answer 16

SAAG <11

Question 17

Which chemotherapy drugs are most likely to cause hair loss?

Answer 17

Taxanes, etoposide, epirubicin, irinotecan, cyclophosphamide

Question 18

When would you choose ganglion impar block over saddle block?

Answer 18

Where continence is preserved as saddle block will lead to incontinence.

Question 19

Name 2 highly emetic chemotherapy regimes?

Answer 19

Anthracycline/cyclophosphamide and Cisplatin

Question 20

Name 3 moderately emetic chemotherapy drugs?

Answer 20

Ifosfamide, irinotecan, carboplatin, doxorubicin/epirubicin, oxaliplatin

Question 21

Naloxone should be administered at what RR?

Answer 21

If less than 8 breaths/min

Question 22

Treatment option for tenesmus in locally advanced rectal cancer?

Answer 22

Consider smooth muscle relaxant such as nifedipine, neuropathic agents or nerve block