Oncology/Palliative Care/MFE Flashcards
(36 cards)
Treatment of N&V with chemo?
1st, 2nd, breakthrough, anticipatory
1st - 5-HT3 antagonist - Ondansetron
(very effective if combined with dexamethasone)
2nd - NK1 antagonist - Apreptide
Breakthrough - Metoclopramide or Ondansetron
Anticipatory - Lorazepam
Management of spinal cord compression?
16mg Dex, followed by 8mg BD
Refer to neurosurgeons - consider surgery esp if single vertebral involvement, or radio-resistant cancer (renal, sarcoma) or unknown primary (get biopsy)
Radiotherapy mainstay of treatment, chemo may be used
How does malignant spinal cord compression normally present?
Radicular pain
Initial Ix for SVCO?
CXR - is there a mass?
Venogram - is there a clot?
CT chest
Treatment options for SVCO if clot?
Thrombolyse - alteplase
Anticoagulate - LMWH or warfarin
Treatment if SVCO from extrinsic compression?
- Dex - always given, but probably doesn’t help
- endovascular stenting treatment of choice
Radiotherapy and chemo can be used depending on cause (SCLC, lymphoma = chemo)
With malignant hypercalcaemia, after corrected Ca, what is the most useful test?
What other tests?
Most: U&E (dehydration)
Phosphate - low in hyperparathyroid (if PTHrp)
Myeloma screen - if unknown malignancy
Bone mets - what is high?
Ca and ALP
Hypercalcaemia - immediate management?
IV fluids - several litres
60-90mg Pamidronate over 2 hours (can cause renal failure so make sure rehydrated first)
Takes several days to a week to work
Signs of malignant pericardial tamponade?
Raised JVP
Pulsus paradoxus (BP drops by 10mmHg on inspiration)
Muffled heart sounds/Pericardial rub
Poor CO - tachycardia with low BP and poor peripheral perfusion
Ix for pericardial effusion?
Rx?
CXR - enlarged heart size
ECG - low amplitude
Echo - rim of pericardial fluid - take cytology
Rx: pericardiocentesis
Potential creation of a pericardial window
Define neutropenic sepsis?
Temp >37.5 with:
- neutrophils <0.5
Management:
- Take bloods
- blood cultures
- Tazocin (or aztreonam + teicoplanin)
Tumour lysis syndrome:
- cause?
- what electrolyte disturbance?
- presentation?
- management?
Rapid destruction of malignant cells due to chemotherapy, causing
- hyperkalaemia
- hyperuricaemia
- hyperphosphataemia
- hypOcalcaemia
Commonly seen in haem malignancies such as Burkitt’s lymphoma, and other extremely chemo-sensitive malignancies
Presentation:
- AKI
- seizure
- arrhythmias
- muscle cramps, cognitive changes
Management:
- as per each electrolyte disturbance
- hydration and allopurinol
What is used for secretions in palliative care?
Hyoscine or Glycopyrronium
What is the preferred opioid for pain in syringe driver?
diamorphine
Codeine to morphine?
divide by 10
Morphine to sc morphine?
divide by 2
Morphine to diamorphine?
divide by 2
oral morphine to oral oxycodone?
divide by 1.5-2
tramadol to morphine?
divide by 10
When upping dose of opioids, how much should it be raised by?
30-50%
In addition to opioids, what else can be used to treat bone pain?
Bisphosphonates, radiotherapy or denusomab
What is the preferred opioid in mild-mod renal impairment?
Oxycodone
What is the preferred opioid in severe renal impairment?
Alfentanyl or buprenorphine
