Professional Development > Part 45 > Flashcards

Part 45 Flashcards

(103 cards)

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1
Q

Type of cancers with highest levels of malnutrition

A

GI malignancies

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2
Q

Unintentional weight loss >10% within 6 months signifies…

A

…substantial nutritional deficit and may indicate poor outcome

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3
Q

Gastrostomy tube

A

An enteral route tube for a patient who cannot move to oral intake within few weeks, placed endoscopically/surgically under local anesthesia

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4
Q

Which is preferred between a gastrostomy tube and a jejunostomy tube?

A

Gastrostomy unless the malignancy is in the stomach because jejunostomy tubes tend to cause diarrhea

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5
Q

Hoxsey therapy

A

Alternative medicine technique that was promoted as being capable of curing cancer that ultimately led to persecution by the AMA for being baseless despite still being used in some populations in mexioc

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6
Q

Acupuncture use in chemo

A

Evidence that it can decrease chemo related nausea and vomiting, can be recommended by medical practitioners and very safe generally unless bleeding tendencies

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7
Q

Butyrate***

A

A bacteria breakdown product from ingested fiber in the intestines that has evidence to inhibit growth of tumors in colon and rectum

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8
Q

Analgesic definition and 2 major classes

A

Drugs that relieve pain without causing loss of consciousness
-Narcotics (act on CNS to inhibit pain impulses) and nonnarcotics (act peripherally to inhibit formation of pain impulse by nociceptive stimuli by inhibiting prostaglandin synthesis)

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9
Q

Function of pain

A

-protective signal (warns of danger or internal disease)

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10
Q

Types of pain (2)

A

-Intense sharp stinging
-dull burning aching
(transmitted by different types of neurons)

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11
Q

Somatic pain vs visceral pain

A

Somatic is well localized to specific local subcutaneous or musculoskeletal tissue while visceral originates in thoracici or abdominal structures and is often poorly localized and referred to somatic structures

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12
Q

Nociceptive (non neuropathic) vs neuropathic pain

A

Nociceptive occurs with normal conduction of nervous system, neuropathic is where nerves are damaged (often from trauma)

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13
Q

Opioid mech of action

A

Bind to the same receptors as endorphins and enkephalins that, alongside seratonin and norepi, are released in the descending inhibitory pathway from the brain to exert an inhibitory effect thru inhibition of adenylyl cyclase resulting in decreased cAMP and decreased Ca2+ influx that pushes out neurotransmitters on a spinal interneuron that is receiving a pain signal

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14
Q

A B sensory fibers

A

Sensory fibers that stimulate the relase of enkephalins from spinal cord neurons that have an inhibitory effect on spinal interneuron receiving pain signal, released upon transcutaneous eleectrical nerve stimulation as well as rubbing or massaging injured tissue

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15
Q

examples of strong opioid agonists (4)

A
  • fentanyl
  • hydromorphone
  • methadone
  • morphine
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16
Q

Examples of moderate to strong opioid agonists (3)

A
  • codeine
  • hydrocodone
  • oxycodone
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17
Q

Combo opioid + acetaminophin/aspirin/ibuprofin helps mediate pain through…

A

….2 separate mechanisms making them very effective to manage pain

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18
Q

Agonist antagonist opioids and example (1)

A

Produce analgesia when administered alone, can antagonize analgesia caused by a pure agonist
-buprenorphine (suboxone or buprenex)

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19
Q

Dextromethorphan/hydrocodone/codeine drugs class and function

A

Opioid with minimal analgesic activity but good antitussive activity to be used in anticough meds

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20
Q

Loperamide (imodium) drug class, use, and how do we prevent abuse of it?

A
  • Opioid with minimal analgesic activity
  • can be used to treat diarrhea
  • prevented from being abused by combo with atropine (lomotil = diphenoxylate + atropine) that gives bad side effects if abused
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21
Q

Example of an opioid antagonist and its function

A

Naloxone (narcan), used to reverse respiratory and CNS depression caused by opioid agonists

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22
Q

Codeine and poor metabolizers

A

Refers to how some are genetically inclined to be poor metabolizers of codeine which is biotransformed into morphine to be active but will not have its desired analgesic effect in these patients

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23
Q

Opioids often alter the sensation of pain rather than…

A

….eliminate it entirely. Patients may still be aware of pain but “don’t care” about it. This is often associated with sense of euphoria and feeling of floating

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24
Q

Drug of choice for dyspnea associated with left ventricular failure or MI pain

A

Morphine

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25
Opioid side effects (7)
- Respiratory depression (reduce sensitivity of respiratory center neurons to carbon dioxide) (most common cause of death with opioid overdose) - sedation - headache - emesis - euphoria/dysphoria - constipation (essential to begin preventative therapy when chronic opioid therapy started) - miosis (characteristic importance to diagnostic of overdose)
26
Characteristic triad of opioid overdosage
- coma - respiratory depression - pinpoint pupils
27
Opioid drug interactions (4)
- CNS depressants (alcohold, benzos) - anticholinergics (intensify constipation) - hypotensive drugs (drop BP) - MAOI - contraindicated
28
Opioid tolerance
With prolonged treatment, some of the effects (especially euphoria, analgesia, sedation and respriatory depression) develop tolerance
29
Opioid induced hyperalgesia
Controversial condition which patients treated with high doses of opioids experience worsening of pain that cannot be overcome by increasing dose (as in toelrance) cdan be managed by decreasing opioid, reducing dose or changing
30
physical dependence definition
Defined as state in which abstinence syndrome will occur if abruptly discontinued, an expected consequence of chronic opioid use
31
Abstinence syndrome definition
An unpleasant but rarely dangerous (unlike CNS depressant withdrawal) that occurs 10 hours after last dose causing rhinorrhea, sweating, anorexia, tremor, etc over 10 days, mitigated by gradual withdrawal
32
Addiction vs abuse
Not the same thing! A case of abuse of a drug even once can kill, while an addiction is a constellation of neurobiologic disease behaviors surrounding use of opioid for purpose other than pain relief
33
Most pain experts state that addiction is uncommon in patients who have...
...no history fo substance abuse or addiction
34
Pseudoaddiction definition
Drug seeking behaviors that occur when pain is undertreated and may mimic addictive behavior, however once controlled patient uses medication as prescribed without addiction
35
Fentanyl potency
High miligram potency about 100x that of morphine
36
Meperedine (demerol) drug class and function
Short term opioid, used for treatment of severe acute pain, short half life and highly irritating but sometimes used for drug induced rigors and shivering analgesia post anesthesic patient
37
Methadone 2 functions
- PO treatment for chronic nociceptive pain - drug abuse treatment programs for opioid addiction
38
Oxycodone (percocet) drug class and potency
Semi synthetic derivative of morphine 9.5 more potent than codeine and 1.5x more potent than *PO* morphine
39
hydrocodone function
analgesic activity equivalent to codeine, PO only to relieve pain and suppress cough
40
Tapentadol (nucynta) drug class and function
Weak opioid agonist and norepi reuptake inhibitor indicated for acute or chronic management of severe pain acting by 2 mechanisms and causing less constipation
41
Buprenorphine (buprenex, subutex, suboxone) use
Used as analgesic and to treat opioid addiction, significant tolerance has not been observed, dependence can occur but abstinence syndrome delayed
42
naloxone (narcan) mech of action
Structural morphine analog that binds to and blocks actions of opioids at their opioid receptors, can reverse most effects including analgesia and resp. depression. In absence of opioids, has no effect - will precipitate immediate withdrawal in someone physically dependent upon opioids
43
Naltrexone (vivitrol) function
Pure opioid antagonist used for alcohol and opioid abuse by preventing euphoria (but can precipitate withdrawal and has no effect on craving)
44
tramadol (ultram) drug class and function
opioid central acting agent, PO agent for treatment of moderate to severe pain and also acts on SNRI
45
Pain assessment
Physical and neurological exams can hep characterize and identify source of pain as well as wong baker face pain rating scale
46
Unlike most other types of severe pain, neuropathic pain responds better to...
....adjuvants such as antidepressants and anticonvulsants
47
Ladder of pain management
- nonopioid first - then opioid +non opioid adjuvant - strong opioid agonist
48
Aspirin and acetominophen together have an equal pain relief as...
...an opioid acetaminophen combo
49
Patient controlled analgesia (PCA pump)
Method of IV administration that allows patient to administer preset amounts of analgesic such as morphine via syringe pump interfaced with a timing device, allows for more constant maintenance around therapeutic range
50
Opioid rotation
Transitioning of a patient from one to another because opioids have different effects profies so goal is to helpminimize adverse effects while maintaining good analgesia, performed in morphine equvialent daily dose (MEDD_
51
Gabapentin (neurontin) drug class, function, and side effects(4)
Inhibits Ca2+ channel activity effective in reducing pain in postherpetic neuralgia and diabetic neuropathy, common side effects include -drowsiness, ataxia, swollen legs, weight gain
52
Pregablin (lyrica) drug class and function
Ca2+ channel activity inhibitor, usually sees analgesia within frst 3 days, same as gabapentin
53
Carbamezapine (tegretol) drug class, function, ADR's (3)
Na+ channel blocker used to treat neuropathic pain and only drug approved for trigem neuralgia - is not apporved for treatment of pain, ADR's include dizziness, double vision, ataxia
54
Tricyclic antidepressants mechanism and function in postherpatic neuralgia, diabetic nephropathy, etc.
-inhibit reuptake of NE and serotonin as well as mild opioid action in the receptor sites
55
Drugs recommended for postherpetic (2)neuralgia and side effects(3)
- SNRI such as duloxetine and milnacipran - dizziness, constipation, liver injury
56
milnacipran (drug class and function)
SNRI, used in fibromyalgia predominantly
57
Topical Diclofenac function
Topical solution approved for treatment of osteoarthritis or musculoskeletal pain of small joints
58
3 constrictures of the esophagus
Cricoid cartilage level, aortic arch level, and esophageal hiatus
59
Lymph nodes of the esophagus
Run longitudinally in the wall of the esophagus, with upper ones going to the cervical nodes and the lower going to the gastric or celiac nodes
60
Histology of the esophagus
Inner circular layer of muscle, outer longitudinal layer of muscle, mucosa composed of stratified squamous epithelium with transition to columnar epithelium lower down
61
Overwhelming majority of neoplasms in the esophagus are (benign or malignant)
malignant
62
Barrett's esophagus definition
Precancerous damage to the lower portion of the esophagus (GERD) where squamous cells have undergone metastasis into columnar, a precancerous condition with risk to develop into adenocarcinoma, responsible for the rising cases of adenocarcinoma in the western world opposed to squamous cell which is due to tobacco and alcohol
63
EGD (esophagogastroduodenoscopy)
Endoscopic procedure to visualize the esophagus to the duodenum
64
Dysphagia is ___ until proven otherwise
esophageal cancer
65
Esophageal cancer should indicate need for MRI for bronchoscopy. This is because...
...the esophagus doesn't have a serosa (unlike stomach) so it can directly transmit to adjacent tissue
66
Esophageal cancer treatment (2) and prognosis
- palliation thru resection or stents - neoadjuvant chemo therapy in case they become candidates for resection - 5 year survival <10-15%
67
Gastric cancer prevalence and prognosis
Decreased in the US, most occur in the antral area, prognosis is terrible
68
Most common tissue type of stomach/esophagus cancer
Adenocarcinoma
69
Gastric cancer ways of spreading
- lymphatics - blood stream - peritoneal seeding - direct extension
70
Blumer's shelf
finding felt on rectal exam that indicates if a tumor has metastasized to the pouch of douglas, usually metastasis of lung or stomach and sometimes palpable on rectal exam
71
Gastric cancer symptoms (6)
- anorexia and weight loss - dysphagia - early satiety - virchow's node (left supraclavicular) - sister mary josephs node (periumbilical area - also a sign of metastatic pancreatic or ovarian cancers) - massive hematemesis
72
Gastric carcinoma therapy (1)
- surgery (subtotal or total gastrectomy) with 6cm distal and 3cm proximal margins - radiation and chemo little benefit
73
Gastrointestinal stromal tumor (GIST) definition
submucosal tumors that protrude into the lumen of the stomach that present with pain, dyspepsia, and GI bleeding
74
colon layers (3)
3 layers of smooth muscle at the rectum, 2 deep to that in the colon, one is referred to as the tenae coli
75
Largest risk factor for colon cancer and some others (2)
- family history in a 1st degree relative - serrated polyposis syndrome - ulcerative colitis
76
Colon cancer symptoms (3)
- nonspecific - change in bowel habits (alternating constipation and diarrhea) - bright red blood per rectum/hematochezia
77
Intussusception definition and treatment
Bowel teloscoping in on itself treated with barium enema and if unsuccessful surgery
78
What type of cancer is most common histologically in the colon?
Adenocarcinoma
79
Carcinoembryonic antigen (CEA) levels
Elevation of the CEA is consistent with more frequent liver metastasis of the colon cancer in some cases
80
colon cancer treatment (2)
- resection - chemotherapy in stage 3 or 4 depending on microsatellite instability
81
Microsatellite instability definition
A series of 4 defective DNA mismatch pairs that if present are indicative of lynch syndrome which places at risk for colon cancer stage 3 or 4 and need for chemotherapy
82
incisors to EG junction distance
35-40cm
83
Most stomach cancers are found in what part?
Antrum
84
Non smokersr who develop lung cancer tend to have genetic alterations encoding....
...epidermal growth factor receptor (EGFR)
85
If a lung tumor is >__cm, than the 5 year survival rate drops off significantly
2
86
Bronchogenic carcinoma
Proliferatory neoplasm arising from primary respiratory epithelium, with 95% being described as either small cell or non small cell
87
Pancoast tumor
Any cancer of the lung that is in the upper lobe and causes horner syndrome and weakness in the hands and shoulder
88
Primary cause of small cell lung cancer
-smoking
89
Why does lung cancer cause excessive mucus production?
Death of the ciliated columnar cell that act potentiate the mucociliary escalator can no longer function so goblet cells must hypersecrete to compensate and protect the integrity of the lungs against pathogens
90
Carcinoid tumor secretion and what does it cause?
Excess serotonin (nausea, shivering, diarrhea)
91
Eaton Lambert syndrome definition
Rare autoimmune disorder characterized by impaired Ach release resulting in proximal muscle weakness, decreased DTR's, and over 50% are associated with thoracic neoplasms seen in small cell lung cancer
92
Benign (noncancerous) causes of solitary pulmonary nodules (3)
- granulomas - rheumatoid or sarcoidosis - aspiration
93
Length time bias
Refers to how the probability of detecting a cancer is proportional to the growth rate of the cancer meaning that detecting a tumor often means its in the later stages
94
2 absolute risk factors for breast cancer development
- Age -sex
95
Treatment of choice for disseminated cancers
Chemotherapy (drug therapy)
96
4 major classes of anticancer agents
- cytotoxic agents (don't have selective toxicity and kill all cells) - hormones and hormone antagonists - immunomodulators - targeted drugs (bind specific molecules)
97
Anticancer agents rae more active against cells with a high or low growth fraction?
High (disseminated cancers such as leukemia and lymphoma) compared to low (solid tumors, respond poorly)
98
Chemotherapy drug dosing
With each successive round dosage must remain the same even though cancer is getting progressively smaller, patient must tolerate same degree of toxicity late in therapy as when began which is often not possible
99
Complete remission
When all signs of disease are absent and cancer has reduced to less than 1 million cells leaving it virtually undetectable - not obvious how long chemo should last, no objective means of determining when to discontinue use
100
Large tumors are less responsive to chemotherapeutic agents. Why?
As tumor increases size, many cells leave cycle and enter G0 causing growth fraction to decline - this growth slows because blood flow to the core of the tumor is low depriving cells of oxygen and nutrients
101
P glycoprotein synthesis in cancer cells
One of the mechanisms of resistance to anticancer drugs seen in cancer cells, can bring about multi drug resistance thru pumping out anticancer drugs resulting in cross resistance to many structurally unrelated drugs
102
Intermittent chemotherapy definition
Because the goal of chemo is to kill 100% of neoplastic cells with limited injury to normal tissues (esp. bone marrow and GI epithelium) the therapy is given on a schedule intermittently to allow for normal cells to repopulate faster than malignant cells (only way chemo will be effective) then dose again to progressively lower the amount of cancer
103
Major toxicities of the anticancer drugs (which is the most serious?) (7)
- bone marrow suppression - neutropenia (most serious can cause normally benign infections to kill)** - thrombocytopenia (increased risk of serious bleeding, avoid anticoagulants) - severe nausea and vomiting - digestive tract injury - diarrhea - alopecia
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