Exam 2: Oncologic Emergency Flashcards
1
Q
Metabolic emergencies
A
- HCM
- TLS
2
Q
Neurologic emergencies
A
Spinal Cord Compression
3
Q
CV Emergencies
A
- Superior vena cava syndrome
- Malignant pericardial effusion
- cardiac tamponade
4
Q
Pulmonary Emergencies
A
pleural effusions
5
Q
Infectious Emergencies
A
Neutropenic Fever
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
7
Q
Drugs to increase uric acid
A
- aspirin
- alcohol
- thiazide diuretics
- caffeine
8
Q
TLS Patho
A
- hyperkalemia exacerbated by AKI
- hyperuricemia –> AKI
- hyperphosphpatemia exacerbates aKI
- hypocalcemia
9
Q
Acute renal failure
A
- 48-72 hours after initiation of therapy
10
Q
TLS principles of managements
A
- identify high risk patients
- monitoring electrolytes
- aggressive hydration
- control of hyperuricemia
11
Q
Low Risk Malignancy TLS
A
- most solid tumors
- myeloma
- indolent lymphomas
- chronic myeloid leukemia
12
Q
Low Risk Malignancy TLS Treatment
A
- monitoring
- hydration ± allopurinol
13
Q
Intermediate Risk TLS Malignancies
A
- DLBCL
- SCLC
14
Q
Intermediate Risk TLS Prophylaxis
A
- monitoring
- hydration ± allopurinol
15
Q
High Risk TLS Malignancies
A
- Burkitt’s lymphoma
- Lymphoblastic lymphomas
- most acute leukemis
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
TLS Monitoring prior to initiation of certain chemo
- uric acid
- phos
- K
- Ca
- LDH
-SCr
- urine output
26
TLS monitoring during first 72 hours after chemo initiation
- uric acid, phos, K, Ca, SCr q8
- patients receiving rasburicase: uric acid 4-8 hrs after dose
27
What is essential in MSCC
early diagnosis and treatment are essential to prevent permanent neurologic damage and possible paralysis
28
MSCC Symptoms
- pain
- motor deficit rapid onset
- sensory deficit
- autonomic dysfunction (bladder and bowel)
29
MSCC Patho
- 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
MSCC Diagnoses
- MRI of whole spine
31
MSCC Treatment
- dexamethasone immediately
- surgery and radiotherapy leads to immediate relief
32
MSCC Treatment Bisphosphonates
- should be offered in patients with vertebral involvement to reduce risk of vertebral fracture/collapse
33
SVC Syndrome
- 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
SVC Syndrome Treatment
- elevation of head
- steroids
- diuretics
- resection
- stenting
- anticoag
- radiation
- chemo
35
MPE
- accumulation of fluid in the pleural space
36
MPE Mgmt
- thoracentesis
- pleural fluid analysis
37
