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General Principles Flashcards

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1
Q

How does 5 FU work?

A

Inhibits thymidylate synthesis to prevent production of thymidine therefore cannot synthesise DNA

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2
Q

How do platinum agents work?

A

Form intra and inter strand DNA links to prevent DNA unwinding and therefore prevent replication

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3
Q

What is the principle of topoisomerase inhibition?

A

This enzyme relieves tension on the ends of DNA when they coil during replication. Inhibition of this causes supercoiling of DNA ends and causes damage.

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4
Q

Name the 6 mechanisms of cancer cell resistance

A 
Decreased uptake 
Increased metabolism 
Altered targets 
Impaired apoptotic pathway 
Efflux pump 
Altered cell cycle checkpoints
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5
Q

Describe the WHO performance status

A 
0 = normal, very good energy
1 = can do everything used to but more tired
2 = 50% of expected 
3 = >50% of day resting
4 = bed bound
5 = dead
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6
Q

Give some side effects of chemotherapy

A 
Alopecia 
Nephrotoxicity 
Neutropenic 
Decreased fertility 
Thrombocytopenia 
Fatigue
Nausea and vomiting 
Skin rashes 
Mucositis 
Myelosuppression
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7
Q

What is the mechanism of action of ondansetron?

A

5HT3 (serotonin) antagonist

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8
Q

What is the MoA of metoclopramide?

A

Dopamine antagonist

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9
Q

What is the MoA of cyclizine?

A

Antihistamine

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10
Q

What is passive immunotherapy?

A

Identify something that is lacking in the patient’s immune system and substitute that

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11
Q

What is active immunotherapy?

A

Trigger something that is already present in the system to increase in function

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12
Q

Give examples of monoclonal antibodies

A

HER 2 inhibitors
VEGF Inhibitors
EGFR inhibitors

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13
Q

Herceptin is used to treat…

A

Breast and gastric Ca

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14
Q

VEGF inhibitors are used to treat …

A

Ovarian and bowel Ca

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15
Q

EGFR inhibitors are used for …

A

Bowel Ca

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16
Q

What are PD-1 inhibitors?

A

Stop the binding of PD-L1 protein of a tumour cell to the PD-1 receptor on the T cell. The binding would stop the T cell attacking so this prevents this.

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17
Q

What are the main SEs of PD-1 inhibitors?

A

Autoimmune flares - all the ‘itis’ conditions

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18
Q

What is the difference between the direct and indirect pathways of radiotherapy?

A

Indirect - produce free radicals which damage DNA

Direct - damages DNA directly

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19
Q

When are you most likely to get neutropenic sepsis?

A

7-10 days post chemotherapy

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20
Q

What is the definition of neutropenic sepsis?

A

Any patient on chemo with a temp >38 and neutrophils <0.5

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21
Q

Lines are most likely to grow which type of organisms?

A

Gram positive cocci

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22
Q

Spinal cord compression is most common in which part of the spine?

A

Thoracic

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23
Q

What examination findings suggest cauda equina?

A

Saddle anaesthesia
Decreased anal tone
Motor/sensory deficits

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24
Q

What is the normal calcium range?

A

2.2 - 2.6 mmol/L

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25
Name some symptoms of hypercalcaemia
``` Nausea Confusion Polydipsia Polyuria Constipation ```
26
What is the management of hypercalcaemia?
``` Fluids - at least 3L saline over 24 hours IV bisphosphonates (make sure properly hydrated before starting) ```
27
Describe the biochemical changes that occur in tumour lysis Syndrome
Hyperuricaemia Hyperkalaemia Hyperphosphataemia Hypocalcaemia
28
How might tumour lysis Syndrome present?
Nausea, vomiting, diarrhoea Haematuria Anorexia Heart failure
29
How do we prevent TLS?
Hydration Allopurinol Rasburicase
30
What are the symptoms of SVC obstruction?
``` SoB Swelling of face, neck, arm Headache Lethargy Choking sensation ```
31
What is the management of SVC obstruction?
Steroids Stenting Chemo/radiotherapy
32
Pain from bone mets tends to respond to ...
NSAIDs | Radiotherapy
33
Pain from the liver tends to respond to...
Steroids | NSAIDs
34
What are the symptoms of opioid toxicity?
``` Pinpoint pupils Hallucinations Drowsiness Vomiting Respiratory depression Myoclonus jerks Confusion ```
35
What is the maximum dose of codeine?
60mg QDS
36
How do you titrate up morphine?
Add up the total daily dose of opioid Half this for their slow release dose Divide by 6 for their PRN dose
37
How does SC morphine dose compare to oral?
SC 10 mg = PO 20 mg
38
Describe how to write a controlled drug prescription
Name and ID of patient Write prescription as normal Write supply and give the pharmacist exact instructions: name and formulation of drug. Total number of tablets written in words and figures.
39
List common causes of nausea and vomiting in cancer patients
``` Infection Hypercalcaemia GI disturbance Gastric stasis Drug related Chemotherapy Anxiety Raised ICP ```
40
Which hormones act at the CTZ?
5HT3 - serotonin Dopamine D2 NK1
41
Which hormones act at the vomiting centre?
Histamine ACh NK1
42
Which hormones act at the VIII nucleus?
Histamine | ACh
43
What is the use of haloperidol in cancer patients?
Potent dopamine blocker Good antiemetic for hypercalcaemia And if low renal function
44
What does metoclopramide do?
Antagonist of dopamine at CTZ | Prokinetic so causes emptying of stomach
45
When is ondansetron most useful?
Chemo Post radiotherapy Post op GI surgery
46
Which antiemetics might you give for a chemical cause of nausea?
Haloperidol | Metoclopramide
47
What anti-emetic would you give in gastric stasis?
Metoclopramide | Domperidone
48
What anti-emetic might you prescribe for bowel obstruction?
Cyclizine | Dexamethasone
49
What antiemetic would you prescribe for raised ICP?
Dexamethasone | Cyclizine
50
What anti-emetic would you prescribe post surgery or radiotherapy?
Ondansetron
51
Which laxative would you prescribe for cancer patients?
Laxido Gentle osmotic effect Doesn’t trigger peristalsis
52
What is sodium picosulfate?
Bowel stimulant and softener
53
What are the treatment options for malignant bowel obstruction?
Drip and suck (IV fluids, NG tube) Venting gastromy rather than NG Steroids to decreased bowel oedema All medicines SC
54
What medication can you give for breathlessness at the end of life?
Low dose morphine | 1-2mg oramorph
55
What are the 5 main symptoms of dying?
``` Pain Nausea/vomiting SoB Respiratory secretion Restlessness/agitation ```
56
What are the 10 hallmarks of cancer?
``` Genome instability and mutation Resisting cell death Sustaining proliferative signalling Evading growth suppressors Enabling replication immortality Inducing angiogenesis Activating invasion and metastasis Reprogramming energy metabolism Tumour promoting inflammation Evading immune destruction ```
57
Define palliative care
Treatment designed to relieve symptoms and improve the quality of life
58
What is the mechanism of action of 5FU?
Inhibits thymidylate synthesis to prevent DNA synthesis
59
Which cancers might we treat 5FU with?
``` Breast Bowel Skin Oesophagus Pancreas ```
60
What is the mechanism of action of methotrexate?
Inhibits dihydrofolate reductase to inhibit DNA synthesis | Acts in the S phase
61
What cancers can we use methotrexate to treat?
``` Leukaemia Lymphoma Breast Lung Head and neck cancers ```
62
Platinum analogues are used to treat...
Testicular, ovarian and lung cancers Lymphomas Eg. cisplatin
63
Give examples of alkylating agents
Cyclophosphamide Chlorambucil Dacarbazine
64
How do alkylating agents work?
DNA cross links are used to interfere with cell replication
65
What cancers are alkylating agents used to treat?
``` Lung Breast Ovary Leukaemia/lymphoma Hodgkin’s Myeloma Sarcoma ```
66
What types of cancer are highly sensitive to chemo?
``` Lymphomas Germ cell tumours Small cell lung Neuroblastoma Wilms ```
67
What tumours have low sensitivity to chemo?
Prostate Brain Renal cell Endometrial
68
Which chemotherapy agents cause cardiomyopathy?
Doxorubicin | High dose cyclophosphamide
69
Which chemotherapy agents cause arrhythmias?
Cyclophosphamide | Etoposide
70
Neutropenic sepsis has neutrophils of ...
Less than 0.5
71
What are the symptoms of cord compression?
``` Back pain Motor/sensory loss Decreased anal tone Bowel or bladder dysfunction Saddle anaesthesia Sexual dysfunction ```
72
What is the best investigation for cord compression?
MRI spine
73
What is the management of cord compression?
Dexamethasone | Radiotherapy or decompressive surgery
74
What is the most common cancer causing SVC obstruction?
Lung
75
What are the symptoms of SVC obstruction?
``` SoB Cough Chest pain Cyanosis Engorged veins on anterior chest wall Swollen face and arm ```
76
What investigations are needed for SVC obstruction?
CXR | CT with contrast
77
What is the management of SVC obstruction?
Oxygen Corticosteroids Radio or chemotherapy Stenting
78
Which cancers are most likely to cause tumour lysis Syndrome?
Leukaemia Lymphoma Germ cell tumours
79
What abnormalities occur in the blood in TLS?
Hyperkalaemia Hyperuricaemia Hyperphosphataemia Hypocalcaemia
80
What can be given to prevent TLS?
Allopurinol | Fluids
81
What are the symptoms of hypercalcaemia?
``` N+V Constipation Polyuria and Polydipsia Confusion Bone and abdominal pain Weakness ```
82
Define malignant neoplasia
Abnormal growth of cells which persists after the initiating stimulus is removed and invades and spreads to distant sites
83
Define dysplasia
Abnormal maturation of cells within a tissue
84
Carcinomas most commonly spread via ...
Lymphatics
85
Sarcomas most commonly spread via ...
Blood
86
How is cell to cell interaction affected?
Decreased expression of cadherins
87
How is cell to stroma interaction affected?
Decreased expression of integrins
88
How do cancer cells metastasise?
Cells synthesise and release metric metalloproteinases which digest collagen allowing the cell to digest ECM and break through the BM
89
Ras mutations are most common in which cancers?
Colon | Lung
90
How do monoclonal antibodies work?
Recognise and attack to specific proteins on the cancer cell surface Mimic natural antibodies and make it easier for immune system to find and attack the cancer cells
91
Give some examples of monoclonal antibodies
Rituximab Cetuximab Trastuzumab
92
Name some tyrosine kinase inhibitors and what they treat
Imatinib - CML, ALL, gastrostomal tumours | Axitinib - RCC
93
Describe DNA replication
Helicase unwinds the DNA helix Leading strand synthesised in 5-3 direction by DNA polymerase Lagging strand synthesised discontinuously - RNA primer is extended by DNA polymerase to form Okazaki fragments DNA ligase joins the fragments
94
What is Lambert Eaten Myasthenia Syndrome?
Development of antibodies to presynaptic calcium channels Usually due to an underlying cancer Presents as proximal muscle weakness
95
MEN1 predisposes to which cancer?
Pancreatic islet cell | Pituitary adenoma
96
MEN2 predisposes to which cancers?
Medullary thyroid | Phaeochromocytoma
97
Neurofibromatosis 1 predisposes to which cancers?
Neurofibrosarcoma Phaeochromocytoma Optic glioma

Cancer Care (7 decks)

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