MFE, Oncology & Palliative Care Flashcards
(55 cards)
Confirmation of death checklist?
Check patient ID
Look for respiratory effort
Check for verbal response
Check for pain response
Assess pupillary reflexes
Palpate carotid artery (> 1 min)
Listen for heart sounds (> 1 min)
Listen for lung sounds (> 1 min)
“Just in case” medicines and indications?
Morphine sulphate (pain, breathlessness)
Midazolam (agitation, anxiety, breathlessness)
Hyoscine butylbromide (respiratory secretions)
Levomepromazine (N&V)
Pain management ladder?
Mild = paracetamol or NSAID (+ adjuvant)
Moderate = weak opioid + above
Severe = change weak to strong opioid
Weak vs strong opioids?
Weak = codeine, tramadol
Strong = morphine, oxycodone, fentanyl, alfentanil, methadone, buprenorphine
Opioids used in mild-moderate vs severe renal impairment?
Mild-moderate (eGFR < 90) = oxycodone
Severe (eGFR < 30) = alfentanil, fentanyl, buprenorphine
Adjuvant pain medications?
Anticonvulsants e.g. gabapentin
Antidepressants e.g. amitriptyline
Corticosteroids e.g. dexamethasone
Local anaesthetics e.g. lidocaine
Bisphosphonates e.g. zoledronic acid
Breakthrough opioid and oral to subcut morphine calculations?
Breakthrough opioid = 1/6th-1-10th of 24 hour dose
Oral to subcut morphine = divide by 2
How much should an opioid dose be increased each day if required?
30-50%
Morphine is an agonist of which opioid receptor?
Mu (µ) receptor
Signs of opioid toxicity vs withdrawal?
Toxicity = bradycardia, hypotension, hypothermia, sedation, coma, miosis
Withdrawal = tachycardia, diaphoresis, agitation, sneezing/yawning, mydriasis
List some oncological emergencies?
Hypercalcaemia
Cord compression
SVC obstruction
Tumour lysis syndrome
Neutropenic sepsis
Features and management of hypercalcaemia?
Bone pain
Kidney stones
N&V, constipation
Fatigue, depression, confusion
Management = IV fluids (1st line), IV bisphosphonate (2nd line)
Features, investigation and management of malignant spinal cord compression?
Back pain
Leg weakness
Incontinence
Sensory changes
Investigation = whole spine MRI < 24 hours
Management = dexamethasone, analgesia, radiotherapy or surgical decompression (if appropriate)
Main 3 cancers which cause bone metastases?
Prostate
Breast
Lung
Most common sites of bone metastases?
Spine (most common)
Pelvis
Ribs
Skull
Long bones
Management options for metastatic bone pain?
Strong opioids e.g. morphine
Bisphosphonates
Radiotherapy
Features, investigation and management of SVCO?
Breathlessness
Swelling of face/neck/arms
Pemberton’s +ve
Headache
Raised JVP
Visual changes
Investigation = CT chest
Management = dexamethasone, analgesia, radiotherapy or endovascular stenting (if appropriate)
Condition which puts patients most at risk of tumour lysis syndrome?
Haematological malignancy e.g. Burkitt’s lymphoma
Features and management of tumour lysis syndrome?
Myalgia
N&V
Fatigue
Heart palpitations
Urinary disturbance
Management = allopurinol, rasburicase
Biochemical features of tumour lysis syndrome and why?
Hyperkalaemia (from tumour cells)
Hyperphosphataemia (from tumour cells)
Hypocalcaemia (↑ PO = ↓ Ca)
Hyperuricaemia (purine catabolism of nucleic acids produces uric acid)
What is the most common pathway for AKI in tumour lysis syndrome?
- High levels of serum PO bind Ca to form CaPO crystals
- Crystals injure or obstruct tubules
- Reduced urine output
Diagnostic criteria for neutropenic sepsis?
Temperature > 38.5 or 2 readings over 38 + neutrophils < 0.5 (or predicted to be < 0.5 in next 48 hours)
Empirical treatment for neutropenic sepsis?
IV tazobactam + piperacillin (tazocin)
Screening tool for delirium and contents?
4-AT:
Alertness
Age/DOB/time/place
Months of the year backwards
Acute change or fluctuating course
