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Palliative and Onc Flashcards

1
Q

3 types of pain and use of opiods

A

Acute- limited duration with obvious cause. Start high then taper off
Chronic- no physiological cause anymore. Avoid at all costs
Cancer and end of life. Start low and slowly titrate

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2
Q

Pain relief for solid tumour

A

Use opioids

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3
Q

Management of neuropathic pain in cancer

A

Opioids semi work
Add co analgesiac such as pregabalin and gabapentin

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4
Q

Management of bone pain in cancer

A

Strong opioid and bisphosphonate
Radiotherapy- most effective, specific tx although does make pain worse initially

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5
Q

Management of nerve compressoin from cancer

A

Opioid and steroid

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6
Q

Liver capsule pain in cancer maangement

A

Opioid with one of NSAID or dexamethasone

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7
Q

Muscle pain/spasm in cancer

A

Muscle relaxant

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8
Q

What are the weak opiods

A

Codeine
Dihydrocodeine
Tramadol
Buprenorphine

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9
Q

What are strong opioids

A

Oxycodone
Moprhine
Alfentanil
Diamorphine

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10
Q

First line opioid used

A

Morphine

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11
Q

Management of side effects of opioids
- nausea
- drowsiness
- constipation

A

Nausea- usually resolves or anti emetic
Drowsiness- reduce dose or resolves
Constipation- stimulant laxative

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12
Q

What class of chemo causes dilated cardiomyopathy

A

Anthracycline

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13
Q

If suspect neoplastic chord compression, what give and so ASAP

A

High dose dexamethasone
Referral for MRI of whole spine in 24 hours

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14
Q

What is gardners syndrome

A

Autosomal dominant FAP with extra colonic tumours- bone and thyroid

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15
Q

Best anti-emetic if undergoing chemo and radiotherapy

A

5HT3 antagonist like ondensatron

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16
Q

Management of superior vena cava obstruction

A

Glucocorticoids initially
Endovascular stenting best option often

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17
Q

What is best management option for superior vena cava obstruction

A

Endovascular stenting

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18
Q

Most common site of bony mets

A

Spine

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19
Q

How do PET scans work

A

Glucose uptake

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20
Q

What anti-emetic use to treat nausea from intracranial tumours

A

Cyclizine first line then dexamethasone

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21
Q

Earliest and most common symptoms of neoplastic spinal chord compression

A

Back pain

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22
Q

What use to monitor teratoma treatment

A

AFP
B HCG

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23
Q

Presentation of vena cava obstruction

A

Visual problems
SOB- most commonly
Swelling of face
Headaches
JVP distention that is pulseless

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24
Q

What chemo agent most likely to cause hypomagnaesaemia

A

Cisplatin

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25
What chemo agent most likely to cause lung fibrosis
Bleomycin
26
What chemo agent most likely to cause haemorrhagic cystitis
Cyclophosphamide
27
What chemo agent most likely to cause peripheral neuropathy
Vincristine
28
Side effects of methotrexate as a chemo
Mucositis Myelosuppression Liver fibrosis
29
General side effects of chemo agents
Nausea and vomiting Myelosuppression Lung fibrosis Cardiomyopathy
30
Other than breast cancer, what does BRCA2 increase risk of
Prostate
31
How investigate metastatic disease of unknown primary
FBC, U&E, LFT, calcium, urinalysis, LDH Chest X-ray CT of chest, abdomen and pelvis AFP and hCG
32
Cancer marker for breast
CA 15-3
33
What can be marker of large cell lung cancer
bHCG
34
Which subtypes of HPV lead to cervical cancer
16, 18 and 33
35
Medications used for secretions in palliative care
Hyoscine Glycopyrronium bromide Bucospan
36
What can be done to reduce secretions in palliative care
Avoiding fluid overload- manage fluids given Medications- hyoscine or glycopyrronium bromide
37
Anti-emetic for intracranial pressure
Cyclizine (1st choice) or dexamethasone
38
First line anti-emetic for vestibular problems
Cyclizine
39
Anti-emetic options for vestibular problems
1st line- cyclizine 2nd- prochlorperazine
40
Management of chemical mediated N&V
Treat underlying cause like hypercalcaemia if possible Ondensatron and metoclopramide are options
41
How manage bowel colic in palliative care
Add hyoscine or glycopyrronium to syrine driver
42
If renal impairment severe what give for palliative pain relief
Buprenorphine or fentanyl
43
If is mild-moderate renal impairment what give for palliative care pain relief
Oxycodone
44
What anti-emetic give for gastroparesis
Metoclopramide
45
Gastroparesis in palliative care presentation
Nausea Constipated however passing wind Early satiety
46
Patient who underwent radiotherapy for mouth cancer now has painful ulcers everywhere
Mucositis secondary to radiotherapy
47
What may be used for a painful mouth at end of life
Benzydamine hydrochloride mouthwash
48
How manage hiccups at end of life
Chlorpromazine Haloperidol
49
Presentation of opiate overdose in palliative patient
Resp depression Low GCS Myoclonic jerks Pinpoint pupils
50
How manage confusion in palliative patient
Screen for other causes- infection, retention, medication etc First line- haloperidol If in terminal stage then subcut midazolam
51
What drug use first line for confusion in palliative patient
Haloperidol
52
When can use midazolam for confusion in palliative patient
If in terminal phase
53
RFx for pressure ulcers
Malnourishment Pain Immobile
54
Management of pressures sores
Create moist environment- hydrocolloid dressing Analgesia Nutritional assesment
55
When use abx for pressure sores
Only if evidence of surrounding cellulits or underlying osteomyelitis
56
Who can consider referral to for pressure sores
Surgeons to debride Tissue viabiliy nurse
57
What use for headache from tumour ICP
Opioid plus dexamethasone
58
When use oxycodone for pain in renal impairment
eGFR 20-40
59
When use alftentanyl for pain relief
eGFR under 10
60
MOA of prochloperazine etc
Phenothiazine- dopamine antagonist
61
Chemical causes of nausea and vomiting
Biochemical- uraemia and hypercalcaemia Drugs- chemo, opioids
62
Best chemical mediated nausea and vomiting anti-emetic if palliative
Haloperidol
63
Post op nausea and vomiting anti emetic
Ondensatron
64
Managing SOB in palliative care
Consider if hypoxaemic or not - then oxygen If feel breathless with no hypoxia - oral immediate release low dose opioid 1st or if does not work short acting benzo If anxiety component - short acting benzo If wheeze from partial obstruction - bronchodilator while awaiting stent/radiotherapy
65
What use for SOB at end of life
Midazolam
66
How manage constipation from opioids in palliative patients
Give senna alongside- do not wait to treat constipation if develops
67
Ladder for constipation in palliative care
1. Senna 2. Add osmotic laxative or surface softener 3. Suppository 4. Phosphate enemas as last resort- really try to avoid
68
What are classes of laxatives and their MOA
Stool softener- lubricates to make softer Stimulant- increases peristalsis Bulk forming- adds weight to faeces which stimulates peristalsis Osmotic- draws water in which makes softer
69
MOA of lactulose
Osmotic agent
70
MOA of docusate
Stimulant and soften stool
71
MOA of movicol
Osmotic agent
72
MOA of fybogel
Bulking agent
73
When increasing morphine in sub cut infuser, how much do by
30-50%
74
What is empirical anti emetic cause if no clear cause identifiable in palliative patients
Metoclopramide
75
What are visceral/serosal causes of nausea
Bowel obstruction Constipation
76
Management of nausea and vomiting from constipation in palliative patients
Cyclizine

Finals (29 decks)

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