Exam 2 Oncologic Emergencies

Question 1

associated malignancies with TLS

Answer 1

• Highest risk: Burkitt’s lymphoma, Lymphoblastic lymphoma, Acute leukemias
• Moderate risk: Low-grade lymphomas, Multiple myeloma, Breast cancer, Small cell lung cancer, Germ cell tumors
• Low risk: Medulloblastoma, Adenocarincomas

Question 2

presenting lab values associated with TLS

Answer 2

• hyperkalemia
• hyperphosphatemia
• hypocalcemia
• hyperuricemia

Question 3

clinical presentation of TLS

Answer 3

• hyperkalemia: Muscle cramps, weakness, N/V/D EKG changes, cardiac arrhythmias/arrest
• hyperphosphatemia: Muscle cramps, tetany, seizures, arrhythmias, renal failure
• hypocalcemia: Muscle cramps, tetany, mental status changes (confusion, hallucinations, seizures)
• hyperuricemia: Acute renal failure

Question 4

prevention of TLS

Answer 4

• aggressive hydration before chemotherapy
• 2000-3000 ml/m2/day x 24-48 hrs prior to therapy
• remove external sources of K and Ph

Question 5

allopurinol

Answer 5

• max dose: 600-800 mg/day
• prevent hyperuricemia, does not treat it
• levels may not fall for 48-72 hours
• renally adjust
• ADE: rash, urticaria

Question 6

Rasburicase (Elitek®)

Answer 6

• treatment and prevention of hyperuricemia
• takes 4 hours to normal levels
• take blood samples to see efficacy; blood samples must be on ice
• caution use in pts w/ glucose-6-phosphatase deficiency
• ADE: rash, mild N/V

Question 7

treatment for hyperkalemia

Answer 7

• Calcium gluconate – stabilize cardiac cells
• Cation exchange resins (sodium polystyrene sulfate;Kayexalate®) – exchange Na+/K+
• NaHCO3, Dextrose 50% + insulin – shift K+ intracellularly

Question 8

treatment for hyperphosphatemia

Answer 8

• Phosphate binders:
• calcium acetate
• PhosLo
• sevelamer
• Renagel

Question 9

associated malignancies with hypercalcemia

Answer 9

• Lung cancer (35%)
• Breast cancer (25%)
• Multiple myeloma (7%)

Question 10

In a normal body, high calcium stimulates the body to release calcitonin to do what?

Answer 10

to decreases kidney Ca reabsorption which results in lower Ca levels

Question 11

Normal Ca level

Answer 11

8.5-10.5 mg/dL

Question 12

equation for corrected Ca

Answer 12

Corrected Calcium (mg/dL) = measured calcium + (0.8 x [4-albumin])

Question 13

When should you use the corrected Ca equation?

Answer 13

for patients with albumin < 4 mg/dL

Question 14

clinical presentation of hypercalcemia

Answer 14

• Polyuria
• Constipation
• Nausea
• Vomiting
• Stupor
• Seizures
• Coma
• Shortened QT interval

Question 15

Classification of Hypercalcemia according to corrected calcium

Answer 15

• Mild: <12
• Moderate: 12-13.9
• Severe: >=14

Question 16

principles of treatment of hypercalcemia

Answer 16

• Rehydration
• Stop bone resorption
• Treat the underlying cause
• Remove external sources of calcium (food, meds)

Question 17

strategies used against hypercalcemia

Answer 17

• Hydration
• Diuretics
• Bisphosphonates
• Calcitonin

Question 18

symptomatic mild hypercalcemia

Answer 18

• 1-2 liters over 2hr
• Loop
• possible IV bisphosphonates

Question 19

bisphosphonates

Answer 19

• takes 4-10 days to work
• last for 4-6 weeks
• ADE: Nephrotoxic, Osteonecrosis of the Jaw, hypocalcemia, arhtralgia, infusion site reactions, fever

Question 20

moerdate hypercalcemia

Answer 20

• 1-2 liters over 2hr
• Loop
• IV bisphosphonates
• possible calcitonin

Question 21

calcitonin

Answer 21

• Rapid decline in serum calcium within 4-6 hrs
• possible tachyphylaxis
• ADE: N/V, facial flushing, injection site pain

Question 22

severe hypercalcemia

Answer 22

• 1-2 liters over 2hr
• Loop
• IV bisphosphonates
• calcitonin

Question 23

associated malignancies with spinal cord compression

Answer 23

• breast
• lung
• prostate
• lymphoma
• myeloma

Question 24

clinical presentation of spinal cord compression

Answer 24

• pain
• weakness
• ataxia
• sensory loss

Question 25

treatment for spinal cord compression

Answer 25

• steroids

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