Back pain Flashcards
(28 cards)
common sites of the spine for degenerative spinal disease
cervical and lumbar area
medication that requires DEXA scan monitoring, and why
indication for medication
aromatase inhibitors; lower oestrogen levels which can accelerate bone loss
indicated in previous history of breast cancer
management by GP for suspected metastatic spinal cord compression
urgent (24-48 hours) MRI whole spine
7 symptoms suggestive of metastatic spinal cord compression
- progressive pain in spine
- severe unremitting spinal pain
- spinal pain aggravated by straining e.g. cough, sneeze, moving
- band like pain
- local spinal tenderness
- nocturnal spinal pain preventing sleep
- neuro symptoms: radicular pain, limb weakness, walking difficulty, sensory loss, bowel/bladder dysfunction
when should the MSCC coordinator be contacted
within 24 hours
2 curative treatments
- surgery
- radical radiotherapy
aim of palliative care?
- increase life expectancy
- improve symptoms now + in the future
adjuvant therapy
- occurs following surgery that has been curative
- systemic treatment aimed at reducing the chance of relapse
systemic treatment options for MSCC
- endocrine therapy
- chemotherapy
- HER2 targeted therapy
- bone targeted therapy
further blood tests following MSCC
FBC: bone marrow infiltration can lead to bone marrow suppression: anaemia + thrombocytopenia
Bone profile: hypercalcaemia
U + E: if hypercalcaemia found
LFTs: marker for liver mets
management of hypercalcemia from bone mets
1st line saline
2nd line IV bisphosphonate infusion
what is vertebroplasty?
injecting cement into a collapsed vertebral body, to help with pain control
Tamoxifen
selective oestrogen receptor modulator; which blocks receptors; preventing oestrogen from reaching them
aromatase inhibitors
prevent conversion of androgens to oestrogens; therefore reducing the level of oestrogen in the blood to undetectable levels
only effective in post menopausal women
hormonal treatments for ER positive cancer (3)
- Tamoxifen
- Aromatase inhibitors
- Fluvestrant
drug to lower oestrogen levels in post menopausal women
Aromatase inhibitors
Fluvestrant
% breast cancers that are Her2 positive
15
combination 1st line trx for Her2 positive breast cancer
- Pertuzumab
- Trastuzumab
- Docetaxel (chemotherapy)
mechanism of Trastuzumab
interacting with HER2 receptor and preventing it being stimulated by growth factors
what can be affected by both Pertuzumab + Trastuzumab
and consequently what must be assessed
cardiac function
LVEF prior to starting and at regular intervals while they continue to receive them
2 ways of measuring LVEF
- echo
- MUGA scan (multi gated acquisition scan… nuclear medicine scan)
What is denosumab
monoclonal antibody, RANK ligand inhibitor
denosumab can treat (2)
- metastatic cancers
- osteoporosis
what is denosumab effective at reducing
skeletal related events e.g. fractures, spinal cord compression, need for interventional surgery or radiotherapy
