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Therapeutics > exam 2 lecture 6 bone modifying agents > Flashcards

exam 2 lecture 6 bone modifying agents Flashcards

1
Q

what percent of cancer causes hypercalcemia? what are the most common tumor types that cause these bony metastases? Non malignant causes?

A

20-30% of all cancer patients. (has decreased due to bisphosphonate use)

lung and breast are most common

non malignant cause- renal failure, hyperparathyroidism

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2
Q

What are the types of HCM (hypercalcemia)

A
  1. humoral (80% of cases) caused by PTHrP (parathyroid hormone).
  2. local osteolytic hypercalcemia
  3. 1, 25 OH secreting lymphomas
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3
Q

signs an symptoms of HCM (include levels)

A

mild- asymptomatic (maybe polyuria/polydipsia)
10-12

moderate
12-14
dehydration, lethargy, confusion

severe >14
renal failure, cardiac issues

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4
Q

Corrected calcium calculation

A

Serum calcium + 0.8 (4 - serum albumin)

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5
Q

tx of mild HCM

A

fluids/hydration

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6
Q

tx of moderate HCM

A

Hydration, 200-400 mk/hr NS
bisphosphonate use (zolindronic acid/ pamidronate)
loop diuretics for patients who develop fluid overload

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7
Q

severe HCM tx

A

> 14
HYDRATION HYDRATION HYDRATION (NS)

Bisphosphonates

calcitonin after bisphosphonates

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8
Q

treatment of treatment refractory HCM

A

Denosumab

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9
Q

chronic HCM management

A

zoledronic acid
pamidronate

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10
Q

bisphosphonates MOA

A

inhibit osteoclast activity
increase mineralization
decrease bone resorption

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11
Q

what are cancer with affinity to bone

A

Prostate (most common)
breast
myeloma
lung
kidney

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12
Q

diagnosis of SRE (skeletal related events

A

symptoms of bony pain/tenderness

bone scan

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13
Q

risk factors for fractures

A

smoking
FH
history of fracture
age

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14
Q

treatment of bone metastases

A

radiation
chemo
IV bone modifying agents (RANK L inhibitors and bisphosphonates)

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15
Q

what to know about radiation therapy in bone metastases

A

85% response rate. Pain relief within 1-2 weeks. If no relief after 6 weeks, unlikely to see benefit

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16
Q

What are the bisphosphonates used for skeletal related events? WHat to keep in mind?

A

Pamidronate and zoledronic acid

ALWAYS dose ADJUST FOR RENAL DOSING

we prefer zoledronic acid because it is quicker to give

17
Q

do we dose adjust zoledronic acid and pamidronate for HCM? WHat about for skeletal related events

A

NO ADJUSTMENT FOR HCM

ADJUST FOR SRE

18
Q

WHat type of drug is denosumab? What is it used for?

A

RANK-L drug

Use 1- bone metastases from solid tumors (drug name is xgeva)

Use 2- osteopenia for women at high risk for fracture and receiving aromatase inhibitor for breast cancer and men receiving ADT (drug name prolia)

19
Q

What to do before denosumab initiation

A

correct hypocalcemia
no renal adjustment needed (this may be why we pick it over bisphosphonate)
Calcium and vit D supplement (same with bisphosphonate)

20
Q

side effects of bisphosphonate

A

osteonecrosis of jaw

21
Q

compare renal dysfunction of zolendronic acid, pamidronate and denosumab?
hypocalcemia?

A

renal-Zolendronic acid> Pamidronate>denosumab (not renally eliminated)

hypocalcemia- denosumab>zoledronic acid

22
Q

How does TLS happen

A

tumor lysis syndrome is a massive release of intracellular contents into blood stream that overwhelms homeostasis. Serious and life threatenig.

23
Q

What type of cancers do we see TLS in? What are the risk factors?

A

associated with aggressive hematologic malignancies, but also in solid tumors.

tumor specific risk favtors- high tumor burden, high tumor grade, rapid cell turnover

Patient specific- age, renal impairement

24
Q

how does TLS present

A

Hyperkalemia
hyperuremia (AKI)
hyperphosphatemia
hypocalcemia

they cause acute renal failure

25
Q

How to prevent TLS

A

Identify high risk pts
monitor electrolytes
aggressive hydration
Control hyperuricemia

it is an oncologic emergency

26
Q

prophylaxis of TLS

A

monitoril
hydration
allopurinol (for low and moderate risk)

(rasburicase for high risk)

27
Q

Difference between allopurinol and rasburicase

A

when TLS occurs, allopurnol does not facilitate breakdown of uric acid, but stops manufacturing of more uric acid

rasburicase can decrease existing uric acid

28
Q

rasburicase limitation?

A

rasburicase
EXPENSIVE
CI in pregnant and breast feeding

29
Q

what is MSCC

A

malignant spinal cord compression. It is an oncologic emergency.

Early diagnosis and treatment is ESSENTIAL to prevent paralysis

30
Q

What is the most common cause of MSCC? symptoms?

A

Prostate most common

Pain, motor deficit, sensory deficit

31
Q

MSCC diagnosis

A

MRI of spine

32
Q

MSCC treatment

A

STEROIDS IMMEDIATELY (dexamethasone)
surgery (needs pt to be good performance status)
radiotherapy

If pt has good PS, surgery immediately, if not, radiation therapy

use bisphosphonates after surgery

33
Q

What is SVC?

A

superior vena cava syndrome.

SVC gradually compressed by tumors
it is also an oncolytic emergency

34
Q

signs and symptoms of SVC

A

facial and arm edema, capillary formation, hypotension

35
Q

SVC syndrome treatment

A

use some type of stent to maintain breathing while we do biopsy to figure out what we are dealing with

alleviation of symptoms- elevation of head, steroids, diuretics

depending on severity, we can do radiation, chemo, anticoag

36
Q

malignant pleural effusion (MPE) common cancer? symptoms?

A

lung, breast, lymphoma

symptoms
1. pleural effusion- accumulation of fluid in pleural space
ranges from no symptoms to acute respiratory distress (dyspnea most seen symptom)

37
Q

MPE management

A

Thoracentesis (drain fluid) and send to lab for analysis

thoracentesis minimizies acute symptoms temporarily, but fluid re accumulates within 30 days

pleurodesis- activates cascade leading to adhesion of pleural layers.

pleural catheters- used to drain fluid frequently. Might cause infection.

38
Q
A

Therapeutics (38 decks)

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