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Finals > Pall/Onc Lectures > Flashcards

Pall/Onc Lectures Flashcards

1
Q

how long does oramoprh take to work and how long does it last

Hence what is the frequency for Oramorph is given regularly

A

Takes 20-30mins to work
Lasts about 4 hours

Hence continuous Oramorph is given 4 hourly (also BD long acting)

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2
Q

What are some adjuvant analgesics and which is the best one

A

Amytryptiline, gabapentin, pregabalin and some anticonvulsants are adjuvants.

Amitriptyline is probably the best one

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3
Q

What type of myoclonus is opioid toxicity (compared to asterixis)

A

It is a FLEXOR myoclonus (throw tea on yourself) as opposed to asterixis which is a negative extensor myoclonus.

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4
Q

Best drug for vivid dreams on opioids

A

Haloperidol 0.5mg. But be careful as vivid dreams is the first step towards hallucinations and opioid toxicity

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5
Q

Does drowsiness and ‘slowness’ last forever if on opioids?

A

No, return to normal after about 5 days

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6
Q

Neoadjuvant versus adjuvant

A

Neo is BEFORE
adjuvant is after
both increase effectiveness of the main treatment

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7
Q

Why is proton beam radiotherapy better than X-ray radiotherapy

A

Because you spare the tissue BEHIND the tumour. Proton beams stop at the target and X-rays go straight through. Physics-y reason why dw

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8
Q

How does radiotherapy cause cell death

A

Creates photoelectrons that damages DNA, causing cell to apoptose. This causes cell death in hours/days/months but also causes increase in cancer in long years time

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9
Q

Why is radiotherapy treatment more effective on cancer cells

A

They have a decreased ability to repair themselves as they replicate much quicker

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10
Q

Why do you give many doses of chemo or radio across a number of weeks? (1)

A
  1. So that you hit the cancer cells in a variety of cell cycle points. Good as cells are more vulnerable in different stages
  2. So that normal cells have time to repair themselves between doses (remember Ca cells not as good at this)
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11
Q

acute SE of radiotherapy

A

Hair loss
Mucositis
Sunburn like rash
Pneumonitis

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12
Q

How can you treatment pneumonitis as acute radio SE

A

prednisolone

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13
Q

long term SE of radiotherapy

A 
telangectasia
lymphedema
fibroses organs (liver, lung)
secondary carcinogenesis
germ cell mutations causing mutations in future generations
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14
Q

How might the chemo TIMINGS be different in palliative versus curative (HINT HINT)

A 
Palliative = single chemo use
Curative = multiple chemos use (so more toxicity)
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15
Q

Chemo acute SE

A

nausea and vomiting
hair loss
mucositis
bone marrow suppression

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16
Q

When do you treat for neutropenic sepsis

A

Whenever there is a temperature above 38 degrees if recently on chemo. 4g tazocin IV

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17
Q

Chemo long term SE

A

chemo brain (10% have permanent long term MCI)
sterility
neuropathy in HANDS and FEET
renal failure

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18
Q

what is CAR-T

A

you take you antigens off the tumour cells and train your normal white cells to target the abnormal antigens and they re-infuse those T cells back in to you. Works very very well but costs about £250k. Can get massive cytokine release and cause ITU admission etc. most useful in non-solid tumours (leukaemia/lymphomas)

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19
Q

Ipilimumab and nivolimumab are examples of

A

checkpoint inhibitors in breast cancer

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20
Q

How do checkpoint inhibitors work

A

T-cells are an important part of our immune system which help destroy cancer cells. Some cancer cells make high levels of proteins that turn T-cells off. Checkpoint inhibitors block this process and reactivate and increase the body’s own T-cell population, enhancing the immune systems own ability to recognise and fight cancer cells.

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21
Q

SEs of checkpoint inhibitors and most common one

A

Any autoimmune disease you’ve ever heard of, you can get when on immunotherapy. Immune colitis is the most common. They can happen any time.

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22
Q

why does herceptin need cardiac moniotirng

A

because cardiac myocytes overexposes HER2 and so herceptin affects

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23
Q

What % of people on immune checkpoint inhibitors will have to be admitted for SEs

A

60%!!!

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24
Q

Tx of colitis from immunotherapy

A

prednisolone and tacrolimus

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25
Q

which cancer drugs are given by a GP

A

aromatase inhibitors
tamoxifen
GnRH analogues

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26
Q

How is goserelin given for prostate cancer

A

Subcut depot 3 monthly

need cytperotone or BICALUTAMIDE for cover at first

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27
Q

Usual timing for neutropenic sepsis

A

1 week after chemo

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28
Q

What is the gold standards framework

A

Basically good palliative care:

Aims to support palliative care patients in their own home
Start identifying patients early on and asses their needs
Make sure important medicines are available in advance

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29
Q

when do you refer to coroner

A 
o	Cause of death not known
o	Not seen doctor in 14 days
o	It was an accident
o	Patient may have had an industrial related disease
o	Death was violent or suspicious 
o	Evidence of neglect
o	Suicide
o	Death during or after an operation
30
Q

which are the only drugs that need an end date on drug chart

A

steroids and antibiotics

31
Q

how is morphine metabolised

A

Into M3G (inactive) and M6G (Active)

32
Q

how is morphine excreted

A

renal (hence be careful in low GFR)

33
Q

How are you ‘careful’ with morphine in low GFR

A 
>60 = no worries huh
30-60 = use 5mg instead of normal 10mg 4 hourly dose (6,10,2,6,10,2)
<30 = use fentanyl instead (or or buprenorphine or oxycodone)
34
Q

Middle of the night anti-emetic choice

A

Central? Cyclizine
Peripheral? Metoclopromide
Unsure? Metoclopromide

35
Q

Which laxatives for morphone

A

Docusate (soften) AND Senna (stimulate)

36
Q

why is lactulose not great in palliative setting

A

It is sweet, causing fermentation, bloating and flatus

37
Q

Is Movicol/Laxido any good?

A

Yes, it is a mix of softner and stimulant just like the ideal combo
BUT
this means you can’t titrate for their poopens

38
Q

You were prescribing Oramorph 4 hourly but want to switch to give Zomorph at noon. When should you give the last dose of Oramorph

A

Also noon. give alongside MR dose as it will take time to kick in.

39
Q

How often do you need to change syringe driver site

A

Every 3 days

40
Q

Dose change when changing to subcut from oral?

A

Half it baby

41
Q

oxycodone versus morphine potency?

A

O is 2x M

42
Q

when do you switch to oxycodone from morphine

A

No pain control + toxicity SEs

43
Q

LDH is a cancer marker of

A

Lymphoma, melanoma, germ cell tumour

44
Q

CUP versus malignancy unknown origin

A

Malignancy of unknown origin = you’ve diagnosed metastatic cancer but don’t know where the primary is yet as you haven’t done full investigations (relatively common)

CUP is an actual diagnosis = cancer of unknown primary. Even when you’ve done all the investigations you wanted to, you still don’t know where the primary is.

Remember at a certain point you stop caring where the primary is….

45
Q

which are the only cancers you can cure with chemo alone

A

Testicular cancer
leukaemia
lymphoma

46
Q

don’t ever take blood from someones arm if they have had a…….. (breast cancer thing)

A

Axillary node clearance

47
Q

palliative vs best supportive care

A

Palliative is to improve length or quality of life, not curative. Can be decade long. Don’t jump to DNACPR

Best supportive care is probably at the end of life and trying to make them comfortable

48
Q

Can F1 sign DNACPR

A

No, but F2 can

49
Q

Adjuvant chemotherapy in breast cancer, what is it’s purpose?

A

NOT to help cure (the surgery is the bit that is doing that)

It is to REDUCE CHANCE OF RECURRENCE

50
Q

Non pharmacological treatments for breathlessness at the end of life

A

Fans
Prolong exhale
Anxiety management
Exercise

51
Q

Drug to reduce sense of breathlessness

A

2.5mg Oramorph

Benzodiazepine if in panic attack

52
Q

Drug for cough in general

  • wet cough
  • dru cough
A

Morphine

  • wet = aid to expectorate with saline neb, PT, mucolytic
  • dry = can add dry linctus
53
Q

Drug for secretions

A

Hyoscine butylbromide (hydro from passed, butyl from lecture, neither from happy app)

54
Q

Electron versus photon radiotherapy uses

A

Electro = better for superficial tumours

Photon (i.e. Xray) = better for deep tumours

55
Q

Skin sparing in radiotherapy?

A

In high energy radiotherapy, the photons are at such high energy that they only star t depositing energy at a depth of 1.5cm below the skin

56
Q

Spinal cord compression radiotherapy or surgery timeline

A

ASApP but within 48 hours

57
Q

why is proton radiotherapy good

A

It protects normal structures that will be deeper than the tumour. Protons are closer to alpha radiation than beta or gamma) and so it delivers it energy in superficial layers (poor penetrance)

58
Q

Why do you have to do a whole spine MRI in cord compression

A

1/3rd have multiple sites

59
Q

PR examination if on chemo?

A

Try to avoid due to risk of sepsis

60
Q

most common GI symptom

A

xerostomia (dry mouth)

61
Q

when is metoclopromide most effective

A

given before mealtimes

62
Q

suppository laxatives? (2)

A

Glycerine (softner)

Bisacodyl (stimulant)

63
Q

Can you use metoclopromide in bowel obstuction

A

In complete obstruction (i.e. colic present) then it is CI

In subacute obstruction (i.e. NO COLIC PRESENT) it is actually the treatment of choice alongside a softner like docusate

64
Q

What drugs do you give for complete obstructin

A

hyoscine bytlbromide (buscopan) for antispasmodic against colic pain
opioids for pain
anti-secretory medication or it’ll build up (hyoscine or ocreotide)

some sort of surgical procedure

65
Q

Performance status?

A 
o	0 = completely independent
1 = only manage light work
2 = independent but about 50% resting
3 = more dependent with >50% resting
4 = completely bed bound
66
Q

MASCC index?

A

MASCC index can identify low-risk febrile neutropaenic patients who can be managed at home

It is a score out of 26. If you score 22 or more then you are LOW risk and can be managed as outpatient.

Features that make you low risk are:

  • normotension
  • solid tumour
  • <60
  • low disease burden
  • presenting as an outpatient
  • not having COPD
67
Q

When can you de-escalate IV tazocin in neutopaenic sepsis

A

after 24 hours of being afebrile and when not neutropenic anymore

68
Q

signs if cord compression is above versus below L1

A

above you get UMN signs
below you get LMN signs

bilat sensory loss always

69
Q

how does dex make you feel

A

energised (so must give it in the morning)

obvs if emergency then dw

70
Q

how do you elicit pembertons sign

A

lift arms for 1 min and you go red, jvp and resp distress

71
Q

when do you give fentanyl instead of morphine

A

eGFR <30 ya bish

Finals (13 decks)

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