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PHRM 864: Therapeutics IV > Bone & Oncologic Emergency > Flashcards

Bone & Oncologic Emergency Flashcards

1
Q

For Hypercalcemia of Malignancy, what are some of the most common tumor types that can cause it?

A
  • Lung, Breast, Hematologic, Prostate
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2
Q

What is the Pathophysiology of HCM?

A
  • Increased Parathroid hormone
  • Increased resorption - Bone Breakdown
  • Decreased Elimination - Kidney Failure
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3
Q

What are some of the the reasons for HCM?

A
  • Humoral: Boney metastase that breakdown the bones –> caused by that parathyroid hormone stimulating osteoclast
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4
Q

What is the way that we calculate Corrected Calcium?

A
  • Serum Ca + 0.8 (4 - Serum Albumin)
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5
Q

What are some of the stages that could occur in HCM?

A
  • MILD: <12mg/dL
  • MODERATE: 12-14mg/dL
  • SEVERE: >14mg/dL
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6
Q

What is important to know about Mild HCM [<12mg/dL]?

A
  • HYDRATE!! [stop Ca supplements]
  • Bisphosphonates for Moderate symptoms [Zoledronic Acid or Panmidronate]
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7
Q

What are some of the signs and symptoms for Mild HCM?

A
  • Constipation, Fatigue [dont know you have it]
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8
Q

What is important to know about Moderate HCM [12-14mg/dL]?

A
  • HYDRATION!! [should lower Ca levels in 24-48 hours –> faster than bisphosphonate]
  • DONT give loop diuretics UNLESS overloaded
  • Bisphophonates [Zoledronic Acid IV over 15 mins; x7d]
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9
Q

What are some of the signs and symptoms for Moderate HCM?

A
  • N/V, Lethargy, Confusion, Weakness
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10
Q

What is important to know about Severe HCM [>14mg/dL]?

A
  • HYDRATION!!!!!!!!!
  • Bisphosphonates
  • Calcitonin [only after Hydration and Bisphosphonates]
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11
Q

What is important to know for Calcitonin in Severe HCM?

A
  • Tachyphylaxis after 48 hours
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12
Q

What are some of the signs and symptoms for Severe HCM?

A
  • Seizures, Coma, Heart Block, Arrhythmias, Asystole
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13
Q

When having refractory HCM, what is the specific treatment that should be used?

A
  • RANK-L Inhibitor: Stops the osteoclasts from breaking down bones [Denosumab]
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14
Q

When experiencing Chronic HCM, what are some of the treatments to use?

A
  • Zolendronic Acid IV over 15 minutes monthly
  • Pamidronate IV over 2 hours monthly
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15
Q

What is do the IV bisphosphonates due in HCM?

A
  • Inhibits osteoclast activity by apoptosis and stops differentiation
  • Decreases bone resorption
  • Concentrates at bone remodeling
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16
Q

What is the epidemiology of Bone Metastases in SREs?

A
  • Cancers that affect the bone [Breast, PROSTATE, Myeloma, Lung, Kidney]
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17
Q

How do you know if you have SREs?

A
  • Bony pains [pinpointed]
  • Radionucleotide bone scan
  • CT, MRI, PET scans
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18
Q

What are some of the risk factors for fractures in women with SRE?

A
  • BREAST CANCER
  • Aromatase Inhibitors, Age > 65, Smoking
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19
Q

What are some of the risk factos for fractures in men with SRE?

A
  • PROSTATE CANCER
  • Androgen Deprivation Therapy, Smoking
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20
Q

What is the general treatment overview for Bone Metastases in SRE?

A
  • Palliation of symptoms
  • Radiation, Chemotherapy, IV Agents, Radioisotopes
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21
Q

What is important to know about Radiation Therapy in SRE?

A
  • Helps with pain relief within 1-2 weeks [do not use longer than 6 weeks]
  • Radioisotopes
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22
Q

What are some of the radioisotopes that are used with Radiation for SRE?

A
  • 131-Iodine: Thyroid Cancer
  • Radium-223: PROSTATE CANCER
  • Strontium & Samarium: Breast and Prostate
23
Q

What is important to know about the Radioisotopes in Radiation for SRE?

A
  • Expensive
  • Myelosuppression
24
Q

What are the IV agents that are used for SRE?

A
  • Bisphosphonates
  • Pamidronate IV 2 hours month
  • Zolendronic Acid IV 15 minutes monthly or bimonthly
25
Q

Do the IV Bisphosphonates need renal adjustment for SRE?

A
  • NEEDS RENAL ADJUSTMENT DOSING [only for SRE not HCM]
26
Q

How do we calculate CrCl?

A
  • = (140-age) x IBW / 72 x Scr
  • x 0.85 if female
27
Q

What is Denosumab?

A
  • RANK L inhibitor
28
Q

What are the other types of Denosumab used for SRE?

A
  • More for refectory
  • BONE METS = Xgeva every 4w
  • Osteopenia = Prolia every 6w
29
Q

What are some of the considerations for Denosumab for SRE?

A
  • SubQ
  • NO renal adjustments
  • EXPENSIVE [~$2500]
30
Q

What are some of the main side effects that can occur from the SRE or HCM treatments?

A
  • Osteonecrosis of Jaw
  • Renal Dysfunction
  • Hypocalcemia
31
Q

What drugs are more likely going to cause Osteonecrosis of the Jaw from SRE or HCM?

A
  • Zolendronic Acid & Denosumab > Pamidronate
  • Monthly > yearly
  • IV > PO
32
Q

What drugs are more likely to cause Renal Dysfunction in SRE or HCM>

A
  • Zoledronic Acid > Pamidronate > Denosumab
  • Bisphosphonate NOT CrCl < 30
33
Q

What is Tumor Lysis Syndrome within Oncologic Emergenices?

A
  • Death of Malignant cells that release intracellular contents into he blood [life threatening]
34
Q

What are some of the risk factors for TLS in Oncologic Emergenices?

A
  • Based on the type of cancer [Solid tumor wont do it BUT hematologic cancers can]
  • Tumor specific
  • Patient Specific: age, renal impairment, uric acid?
35
Q

When the tumor cells lysis, what are some of the things that can happen?

A
  • Hyperkalemia [Increased K]
  • Hyperuricemia [Increased Uria]
  • Hyperphosphatemia [Increased P]
  • Hypocalcemia [Decreased Ca]
36
Q

What is are some of the side effects based on pathophysiology for TLS in Oncologic Emergenices?

A
  • Hyperkalemia = cardio issues
  • Hypocalcemia = caused by the hyperphosphatemia
  • ALL pass through the kideny SO kidney failure increases all them
37
Q

What are some fo the prinicple of management for TLS in Oncologic Emergencies?

A
  • Identify high risk patients
  • Monitoring Electrolytes
  • HYDRATION
  • Control the Hyperuricemia
38
Q

What are the patients that are more high risk for TLS in Oncologic Emergencies?

A
  • Those with Lymphoma or Leukemias
39
Q

What are some of the Prophylaxis measures to take for TLS in Oncologic Emergenices?

A
  • Montoring & Hydration
  • Low and Moderate: Allopurinol
  • High: Rasburicase
40
Q

What is the way that Allopurinol can help within TLS?

A
  • Uric Acid and Xathine can lead to AKI
  • Allopurinal STOPS FUTURE production of uric acid NOT breakdown current
  • Use before chemo
41
Q

What is MOA for Rasburicase in High Risk TSL?

A
  • Can stop breakdown CURRENT and FUTURE uric acid in 4 hours
  • Use in patients that cant use Allopuinol
42
Q

What are some of the limitations for Rasburicase in High Ris TSL?

A
  • G-6-P deficiency
  • CONTRAINDICATED in pregnant or breast-feeding
  • $$$$$$
43
Q

Within TSL, what are some of the ways that we can manage electrolyte abnormalites?

A
  • Hyperkalemia [K]: Calcium Gluconate, Dextrose, Insulin, Sodium Bicarb, loop diuretices
  • Hyperphophatemia [P]: Phospate Binder
  • Hypocalcemia [Ca]: DONT treat asymptomatic; Symptomatic = calcium gluconate
44
Q

What is Malignant Spinal Cord Compression within Oncologic Emergenics?

A
  • Compression of spinal cord that is caused by Breast, Lung PROSTATE cancers
  • THIS IS AN EMERGENCY!!!!
45
Q

What are some of the Symptoms of MSCC?

A
  • Pain: back pain is most common
  • Motor Deficit: weakness & gait
  • Sensory Deficit: numbness of toes or fingers
  • Autonomic Dysfuction: cant make it to the bathroom [RED FLAG]
46
Q

If you suspect someone to have MSCC, what is important to do first?

A
  • STERIODS [Dexamethasone]
  • MRI of the WHOLE spinal cord
47
Q

What are some of the treatment options for MSCC?>

A
  • STEROIDS IMMEDIATELY: Dexamethazone 10 mg
  • Surgery & Rads are the only treatments that has immediate relief
48
Q

What is important to know about Radiation & Surgery in MSCC?

A
  • Radiotherapy: stops further growth
  • Surgery: Laminectomy, Vertebroplasty, Kyphoplasy [concrete balloon]
49
Q

What is Superior Vena Cava Syndrome in Ocologic Emergenies?

A
  • The compressing of the SVC causes a decrease in drainage from the head, neck, and upper extremities
  • NOT really an oncologic emergency??
50
Q

What are some of the signs and symptoms for SVC?

A
  • Facial and Arm Edema, Cough, Stridor, Dysphagia
51
Q

What is the way that we treat SVC syndrome ?

A
  • Alleviated the symptoms & treat cause
  • Stents, anticoag?
  • Elevate the head [decreased edeme], Steroids [inflammation], Diuretics [decrease fluids]
52
Q

What is a Malignant Pleural Effusion in Onologic Emergenceies?

A
  • Fluid in the plural space by the lungs
  • Can be causes by Lung, Breast and Lymphoma
53
Q

What are the symptoms PE and how do we diagnosis it?

A
  • NO real symtpoms: SOB & Pain
  • Chest x-ray is 1st
54
Q

How are we able to manage MPE?

A
  • Thoracentesis: Needle that removes fluid from pleural area [drain 1-1.5L; could cause infections]
  • Cathator

PHRM 864: Therapeutics IV (28 decks)

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