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PHRM 864 > Exam 2: Oncologic Emergency > Flashcards

Exam 2: Oncologic Emergency Flashcards

1
Q

Metabolic emergencies

A
  • HCM
  • TLS
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2
Q

Neurologic emergencies

A

Spinal Cord Compression

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3
Q

CV Emergencies

A
  • Superior vena cava syndrome
  • Malignant pericardial effusion
  • cardiac tamponade
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4
Q

Pulmonary Emergencies

A

pleural effusions

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5
Q

Infectious Emergencies

A

Neutropenic Fever

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6
Q

What is TLS

A
  • metabolic derangements resulting from the death of malignant cells
  • massive release of intracellular contents into the blood stream that overwhelms the body’s homeostasis
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7
Q

Drugs to increase uric acid

A
  • aspirin
  • alcohol
  • thiazide diuretics
  • caffeine
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8
Q

TLS Patho

A
  • hyperkalemia exacerbated by AKI
  • hyperuricemia –> AKI
  • hyperphosphpatemia exacerbates aKI
  • hypocalcemia
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9
Q

Acute renal failure

A
  • 48-72 hours after initiation of therapy
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10
Q

TLS principles of managements

A
  • identify high risk patients
  • monitoring electrolytes
  • aggressive hydration
  • control of hyperuricemia
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11
Q

Low Risk Malignancy TLS

A
  • most solid tumors
  • myeloma
  • indolent lymphomas
  • chronic myeloid leukemia
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12
Q

Low Risk Malignancy TLS Treatment

A
  • monitoring
  • hydration ± allopurinol
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13
Q

Intermediate Risk TLS Malignancies

A
  • DLBCL
  • SCLC
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14
Q

Intermediate Risk TLS Prophylaxis

A
  • monitoring
  • hydration ± allopurinol
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15
Q

High Risk TLS Malignancies

A
  • Burkitt’s lymphoma
  • Lymphoblastic lymphomas
  • most acute leukemis
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16
Q

High Risk TLS Prophylaxis

A
  • monitoring
  • hydration
  • rasburicase
17
Q

TLS: Aggressive hydration

A
  • improves intravascular volume, renal perfusion, and GFR
  • decrease risk of life-threatening hyperkalemia
  • may require use of diuretics
18
Q

Urine output maintenace in TLS

A
  • 80-100 mL/m2/hr
  • may require diuretics
19
Q

TLS Hyperuricemia MGMT

A
  • start at least 12-24 hours prior to chemo
  • may require renal adjustment
  • allopurinol until normalization of uric acid and other lab values
20
Q

Limitations of allopurinol

A
  • does not reduce already formed uric acid
  • may take several days to lower uric acid
  • decreases clearance of 6TMP, azathioprine, high dose MTX
21
Q

Rasburicase

A
  • decreases uric acid including already formed uric acid within 4 hours
  • CI in women pregnant or breast-feeding
  • expensive
    -GTPD deficiency
22
Q

TLS Hyperkalemia MGMT

A

Mild
- give IV fluids and loop
- SPS

Sever ≥6
- C A BIG K DROP

23
Q

Hyperphosphatemia TLS MGMT

A
  • minimize phosphate intake
  • phosphate binder
24
Q

Hypocalcemia TLS MGMT

A
  • do not treat as asymptomatic
  • small amounts and slow admin of IV calcium gluconate
  • usually corrects itself after hyperphos is corrected
25
Q

TLS Monitoring prior to initiation of certain chemo

A
  • uric acid
  • phos
  • K
  • Ca
  • LDH
    -SCr
  • urine output
26
Q

TLS monitoring during first 72 hours after chemo initiation

A
  • uric acid, phos, K, Ca, SCr q8
  • patients receiving rasburicase: uric acid 4-8 hrs after dose
27
Q

What is essential in MSCC

A

early diagnosis and treatment are essential to prevent permanent neurologic damage and possible paralysis

28
Q

MSCC Symptoms

A
  • pain
  • motor deficit rapid onset
  • sensory deficit
  • autonomic dysfunction (bladder and bowel)
29
Q

MSCC Patho

A
  • development of compression in the spinal column from tumor cells
  • destruction of cortical bone by tumor compound –? caused by cytokines, inflammatory markers, and neurotransmitters
30
Q

MSCC Diagnoses

A
  • MRI of whole spine
31
Q

MSCC Treatment

A
  • dexamethasone immediately
  • surgery and radiotherapy leads to immediate relief
32
Q

MSCC Treatment Bisphosphonates

A
  • should be offered in patients with vertebral involvement to reduce risk of vertebral fracture/collapse
33
Q

SVC Syndrome

A
  • thin walled SVC gradually compressed by tumors outside the vessel
  • impaired venous drainage the head, neck, and upper extremities
  • occurs in the setting of an extrinsic compression or other occlusion of the superior vena cava
34
Q

SVC Syndrome Treatment

A
  • elevation of head
  • steroids
  • diuretics
  • resection
  • stenting
  • anticoag
  • radiation
  • chemo
35
Q

MPE

A
  • accumulation of fluid in the pleural space
36
Q

MPE Mgmt

A
  • thoracentesis
  • pleural fluid analysis
37
Q
A

PHRM 864 (10 decks)

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