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Oncology and Palliative Flashcards

(49 cards)

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1
Q

Name some mechanisms that chemotherapy works?

A 
DNA cross links - platinum
Damage tubulin - vinca alkaloids
Topoisomerase 1 and 2 inhibitors
Antimetabolites
Free radical generator
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2
Q

what is chemotherapy?

A

cytotoxic drugs used to kill cancer cells

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3
Q

SE of chemotherapy?

A

myelosuppression, alopecia, infertility, fatigue

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4
Q

How do we work to prevent anaphylaxis with chemotherapy?

A

give steroids/antihistamines
slower infusion rates
specialist nurses on sight

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5
Q

Name some oncological emergencies

A

extravasation
coronary artery spasm
neutropenic sepsis

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6
Q

Name some late effects of chemotherapy

A 
Infertility
early menopause
atherosclerosis
HF/lung damage
chemo brain
secondary cancers
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7
Q

what is extravasation during chemotherapy?

A

if chemotherapy cannula accidently moves SC and is administered it can cause necrosis of large patches of skin

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8
Q

what is coronary artery spasm during chemotherapy?

A

typically occurs with 5FU
looks like ACS on ECG
stop infusion and involve cardiology
give NITRATES

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9
Q

what anti-emetics can you give to patients struggling with N&V during chemo?

A

metoclopromide, domperidone

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10
Q

why is there an increased risk of haemorrhage in cancer patients?

A

chemo + disease = reduced platelets
cancer can erode vessels
low numbers of clotting factors

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11
Q

How do you manage SCC in a cancer patient?

A

IV dexamethasone

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12
Q

how do you manage constipation/diarrhoea in a cancer patient?

A

loperamide, laxative

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13
Q

how does BM suppression present?

A

THROMBOCYTOPENIA - easy bruising and bleeding
ANAEMIA - fatigue and pallor
NEUTROPENIA - neutropenic sepsis

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14
Q

what is the definition of neutropenic sepsis?

A

neutrophil count <1.0 and a fever >37.5 in a patient undergoing chemotherapy (increased Rx due to myelosuppression)

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15
Q

what do you give to a patient with suspected neutropenic sepsis?

A

Tazocin

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16
Q

Ix for a patient with suspected neutropenic sepsis?

A

FBC/UE/LFT/Cr/CRP/lactate/blood cultures/urine cultures/swab central line

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17
Q

how do we try and increase appetite of cancer patients?

A

steroids

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18
Q

how do we manage painful spinal mets?

A

analgesia, bisphosphonates, palliative radiotherapy, vertebroplasty

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19
Q

how can we manage stomatitis?

A

difflam mouthwash

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20
Q

name some types of immunotherapy?

Study These Flashcards
A

MAbs, interferons, interleukins, oncolytic virus therapy, cancer vaccines

21
Q

name some side effects of immunotherapy treatment?

Study These Flashcards
A

hepatitis - deranged LFTs/jaundice
colitis - perforation, pain and blood in stools
pneumonitis - cough/SoB

22
Q

name some cancer functional assessments? why are they important

Study These Flashcards
A

ECOG performance status (0 = fully active –> 5 = dead)
clinical frailty score

important because it strongly correlates to outcome

23
Q

what can we use to dictate outcome predictions for cancer patients

Study These Flashcards
A

cancer functional assessments
exercise tolerance
daily housework
Albumin/Cr/Hb/liver and renal function/pulm function/TNM staging

24
Q

Indications for radiotherapy

Study These Flashcards
A

medically unfit for surgery, anatomically unrescectable, close to vital structures, adjuvent to reduce recurrence

25
what is radiotherapy?
high dose X rays to destroy cells (cancer cells can't repair themselves very well but normal cells can.)
26
name some different modalities for radiotherapy?
external beam, electrons, brachytherapy
27
acute SE of radiotherapy?
``` local sunburn effect fatigue reduced taste pneumonitis erythema irritation ```
28
late effects of radiotherapy?
``` scarring infertility lymphodoema delayed healing reduced salivary flow hypothyroid ```
29
what are the features of a benign tumour?
localised, non invasive, resembles normal tissue and encapsulated
30
what are the features of a malignant tumour?
invasive, metastatic, rapid growth, poorly defined border, necrosis
31
mechanism of hypercalcaemia of malignancy? 3 mechanisms
1. secretion of PTH by tumour 2. local realease of factors increasing osteoclast proliferation 3. autonymous production of calcitriol by lymphoma
32
Mx of hypercalcaemia of malignancy?
IV normal saline Bisphosphonates Furosemide
33
What is SVC obstruction? and what is the commonest cause?
venous return for the head/thorax/upper extremities is obstructed, which increases venous pressure commonest cause: cancer (lung cancer and lymphoma)
34
Symptoms of SVC obstruction?
oedema of face and upper extremities, facial plethora, dysponea and cough, distended chest and neck veins, , raised JVP
35
Ix for SVC obstruction?
CXR, CT thorax and contrast, USS upper extremities
36
what is tumour lysis syndrome?
combination of metabolic and electrolyte abnormalities occuring spontaneously in cytotoxic treatment due to excessive cell lysis.
37
What are the metabolic abnormalities in tumour lysis syndrome and what do these cause?
HYPERURICAEMIA - increased uric acid crystals --> AKI HYPERPHOSPHATAEMIA - urinary obstruction HYPERKALAEMIA - arrhythmia HYPOCALCAEMIA - cramps/tetany
38
presentation of tumour lysis syndrome?
syncope, chest pain, dyspnoea, N&V, abdo urinary colic, muscle weakness, tetany
39
what causes carcinoid syndrome? what are the features?
increased serotonin from neuroendocrine tumours | flushing/diarrhoea, wheeze palpitations, abdo pain
40
what does palliative medicine focus on?
physical, psychological and spiritual - supportive care/EoL/terminal care/bereavement support
41
name some antiemetics and where they act?
bowels - domperidone bowels and brain - ondasetron biochem and brain - haloperidol brain - cyclizine
42
Name some simple analgesics and their side effects?
paracetamol - liver impairment and cachexia | NSAIDS - renal impairment, GI bleeds, asthma
43
Name 3 weak opioids
codeine, dihydrocodeine, tramadol
44
name some strong opioids?
morphine, diamorphine, oxycodone, buprenorphine, fentanyl
45
Common SE of opioids?
constipation, sedation, nausea, dry mouth, resp depression
46
which opiods are best for renal impairment?
fentanyl, buprenorphine
47
name some alternative adjuvant analgesics?
``` antidepressants e.g TCAs pregabalin antispasmodics e.g. baclofen steroids benzos bisphosphonates ```
48
signs that a patient is dying?
``` weight loss and reduced appetite fatigue reduced mobility social withdrawan pulse changes, mottled, cool peripheries noisy secretions and laboured breathing ```
49
Name some symptoms in the dying patient and how you would manage them?
``` PAIN - PRN morphine syringe driver and patch BREATHLESSNESS - PRN opioid SECRETIONS - PRN buscopan N&V - Haloperidol AGITATION - midazolam ```

Finals (21 decks)

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