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Year 4 Oncology > Symptomatic treatment > Flashcards

Symptomatic treatment Flashcards

1
Q

Symptoms of cancer

A

Breathlessness
Nausea and vomiting
Constipation

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2
Q

Causes of cancer related breathlessness (9)

A 
Anaemia 
PE 
Congestive cardiac failure 
COPD 
Respiratory tract infection - pneumonia 
Pleural effusion 
Pericardial effusion 
SVCO
Anxiety
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3
Q

Investigations for breathlessness

A

Anaemia - Bloods

PE - CTPA

Congestive cardiac failure - CXR, BNP

COPD - Spirometry

Pneumonia - Bloods, culture, CXR

Pleural effusion - CXR

Pericardial effusion - CXR, CT

SVCO - CXR

Anxiety - Bloods

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4
Q

Treatment for breathlessness

A

Anaemia - treat cause e.g. iron supplements or transfusion

PE - Enoxaparin (LMWH or DOAC)

Congestive cardiac failure - Diuretics, ACEi

COPD - bronchodilators

Pneumonia - abx

Pleural effusion - aspiration, chest drain (pluerodesis)

Pericardial effusion - paracentesis, corticosteroids

SVCO - Stent, radiotherapy or steroids

Anxiety - CBT, benzodiazepines, SSRIs

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5
Q

General management of breathlessness

A

Consider oramorph 1 - 2mg PRN

If anxiety - sublingual lorazepam

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6
Q

Common causes of nausea and vomiting

A

Infection

  • UTI
  • pneumonia,
  • gastro-enteritis
  • thrush

Metabolic

  • renal impairment
  • hepatic impairment
  • hyponatraemia
  • hypercalcaemia
  • sepsis
  • tumour toxins
  • stopping steroids quickly

Drug related

  • opiods
  • abx
  • NSAIDs
  • diuretics
  • digoxin
  • SSRIs
  • chemo

Gastric stasis

  • pyloric tumours
  • ascites
  • hepatomegaly
  • opioids
  • anticholinergics
  • DKA- pancreatic cancer

GI disturbance

  • constipation
  • gastritis
  • ulceration
  • obstruction

Organ damage

  • distention
  • obstruction
  • radiotherapy

Neurological

  • raised ICP
  • motion sickness
  • meningeal disease

Psychological - anxiety/ fear

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7
Q

Raised ICP symptoms

A

Headaches
Confusion
Visual disturbances
Worse in the morning

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8
Q

Symptoms of hypercalcaemia

A 
Headaches 
Constipation 
Bone pain 
Nausea
Dark urine
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9
Q

Receptors in the chemo trigger zone

A

D2 - Dopamine receptors

NK1 - natural killer receptors

5HT3 - Serotonin receptors

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10
Q

Receptors in the vomiting centre

A

Achm - Acetylcholine receptors

H1 - histamine receptors

5HT2 - Serotonin receptors

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11
Q

Receptors in the VIII nucleus

A

Achm - Acetylcholine receptors

H1 - histamine receptors

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12
Q

What triggers the chemo trigger zone

A

Toxins in blood

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13
Q

What triggers the vomiting centre

A

Higher centres - anxiety/ fear/ pain

Autonomic afferents

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14
Q

Medication for nausea and receptors

A

Haloperidol - D2

Metoclopramide - D2, 5HT3

Domperidone - D2

Cyclizine - Ach, H1

Levomepromazine - D2, 5HT2, Ach, H1

Ondansetron - 5HT3

Hyoscine hydrobromide - Ach

Prochlorperazine - D2, Ach, H1

Aprepitant - NK1

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15
Q

Feature of prochlorperazine

A

Weak antiemetic

Used in GP

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16
Q

Which anti-emetics cause sedation

A

Levomepromazine

Hyoscine hydrobromide

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17
Q

Which antiemetic is used for chemical causes of nausea

A

Haloperidol or metoclopramide if gastric stasis

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18
Q

Features of chemical nausea

A 
Persistent 
Often severe 
Unrelieved by vomiting 
aggravated by the sight and smell of food 
Drowsiness and confusion
19
Q

Which antiemetic is used for gastric stasis causes of nausea

A

Metoclopramide

Domperidone

20
Q

Features of gastric stasis nausea

A

Fullness and regurgitation

Reduced appetite

Large volume of vomit

Vomiting relieves nausea

Epigastric discomfort

Hiccups

21
Q

Which antiemetic is used for functional causes of nausea (bowel obstruction)

A

Cyclizine

22
Q

Features of functional nausea due to bowel obstruction

A

High obstruction - regurgitation, forceful vomiting of undigested food

Low: colicky pain, feculent vomit, visible peristalsis

23
Q

Which antiemetic is used for raised ICP intracerebral causes of nausea

A

Cyclizine and dexamethasone to reduce cerebral oedema

24
Q

Features of nausea due to raised ICP intracerebral

A

Nausea worse in the morning

Projectile vomiting

Worse with head movements

Headache

25
Q

Which antiemetic is used for anxiety causes of nausea

A

Benzodiazepines

26
Q

Features of nausea due to anxiety

A

Anxiety
Fear
Anticipation

27
Q

Which antiemetic is used for nausea caused by post op or post radiotherapy

A

Ondansetron

28
Q

Which antiemetic is used for nausea caused by constipation

A

Laxatives

Metoclopramide

29
Q

Features of nausea due to constipation

A

Feculent vomit

Abdominal distension

30
Q

Risk factors associated with chemotherapy induced N+V

A

Female

Age < 50 yo

Past Hx of N+V with pregnancy, chemo or motion sickness

31
Q

Side effects of aprepitant

A

Constipation

Headache

32
Q

Route and regime of antiemetics

A

Often given SC due to poor oral absorption

Given before, morning off and after chemotherapy

Use regularly

Can combine anti-emetics with different MOA

33
Q

Features of constipation

A

Hard faeces which is difficult to pass

Reduced frequency

Sense of incomplete evacuation

Faecal incontinence

Colicky abdo pain and abdo distension

Flatulence

N+V

34
Q

Causes of constipation

A

Disease related - immobility, reduced food intake, intra-abdominal and pelvic disease

Fluid depletion - poor fluid intake, fluid loss e.g. vomiting

Weakness - inability to raise intra-abdominal pressure e.g. cardiac failure

Intestinal obstruction - recurrence, adhesions, surgery

Medication - opioids, diuretics, anticholinergics, 5HT antagonists

Biochemical - hypercalcaemia, hypoklaemia

Other - pain when defecating, diverticulitis

35
Q

Stimulant laxatives

A

Senna
Bisacodyl

Reduce bowel transit times

36
Q

Softener laxative

A

Docusate

Increase water penetration of stool

37
Q

Stimulant/softener laxative

A

Sodium picosulfate

38
Q

Osmotic laxatives

A

First line

  • Lactulose
  • Movicol
  • Laxido

Holds water in the gut lumen

39
Q

Side effects of osmotic laxatives

A

Flatulence

Bloating

40
Q

Suppositories

A

Glycerin - softner

Bisacodyl - stimulant

41
Q

Types of malignant bowel obstruction

A

Mechanical - due to tumour within the gut or outside bowel wall

Functional - infiltration of myenteric plexus

42
Q

Treatment of malignant bowel obstruction

A

Surgical intervention:

  • Endoscopic stenting
  • Venting gastrostomy to decompress
  • Cautious use of prokinetics

If inoperable:

  • IV fluids - correct electrolytes
  • NG tube
  • Trial of dexamethasone
  • Analgesics
43
Q

Broad spectrum anti-emetic

A

Levomepromazine

Year 4 Oncology (21 decks)

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