Management of cancer patients + imaging LC Flashcards
Malignancy prediction of cutaneous and subcutaneous neoplasms in canines using B-mode ultrasonography, Doppler, and ARFI elastography
Malignancy was associated with non deformable tissue and shear wave velocity > 3.52m/s
verified association between Heterogeneous echotexture, invasiveness, hyperechoic spots, cavity areas with malignancy
Effect of slice thickness on computed tomographic perfusion analysis of the pancreas in healthy dog
Results supported that a thin slice thickness of 2.4 mm can be used for assessment of pancreatic perfusion variables in healthy dogs
Use of computed tomography and radiation therapy planning software to develop a novel formula for body surface area calculation in dogs
Contoured BSA differed from the current formula by −9% to +19%.
Nonlinear regression on untransformed data yielded BSA = 0.0134 × body weight [kg]∧0.4746 × length (cm)∧0.6393 as the best-fit model.
Metastatic diagnosis of canine sternal lymph nodes using computed tomography characteristics
Size (StLN-to-second sternebraratio [ratio-size]) and precontrast attenuation achieved a specificity and positive predictive value of 100% of identifying metastasis to sternal LN
Staging canine patients with appendicular osteosarcoma utilizing fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography compared to whole body computed tomography
Comparing F-FDG PET/CT to whole body CT 13 osseous lesions concerning for mets were identified on PET/CT that would have been missed and 4 comordid neoplastic conditions
F-FDG PET/CT is more efficacious than whole body CT for staging
what is the anitdote to mustargen extravasation
sodium thiosulfate
vesicant
Pilot study to evaluate the efficacy of lymphotropic nanoparticle enhanced MRI for diagnosis of metastatic disease in canine head and neck tumours
LNMRI has the potential to be a sensitive and specific method of diagnosing lymph node metastasis
LNMRI utilizes ultra-small superparamagnetic iron oxide nanoparticles (USPIOs) to help in the detection of metastatic disease in lymph nodes. USPIOs are phagocytized and localized to normal lymph nodes where they assist in evaluation for regions of effacement by cancerous cells.
Loperamide (Imodium)
MOA and tox
acts on opioid receptors in the gastrointestinal tract, slowing intestinal motility and reducing fluid secretion
operamide can cause central nervous system depression, manifested by sedation, ataxia, and respiratory depression, especially at high doses.
Cats are more sensitive to loperamide toxicity, and even small doses can lead to severe symptoms such as bradycardia, hypothermia, and respiratory depression.
Overdose can be life-threatening and requires immediate veterinary attention
Kaolin-Pectin - mech /tox
Kaolin absorbs water and toxins in the gastrointestinal tract
safe
Metronidazole (Flagyl)- mech/tox
Side effects can include gastrointestinal upset, nausea, vomiting, and in rare cases, neurotoxicity (e.g., ataxia, seizures) at high doses or with prolonged use.
Metronidazole should be used cautiously in animals with liver disease.
mech - disrupts protein and dna synthesis Bacteroides spp.
Clostridium spp.
Fusobacterium spp.
Peptostreptococcus spp.
canalevia- Crofelemer
normalizes the hypersecretion of both the cyclic adenosine monophosphate (cAMP)-stimulated cystic fibrosis transmembrane conductance regulator (CFTR) chloride (Cl ) channel and the calcium-activated Cl channel (CaCC) at the luminal membrane of intestinal enterocytes. Disregulation of the CFTR and CaCC channels increases the osmotic gradient and causes excessive fluid influx into the lumen, resulting in secretory diarrhea.
capromorelin mech
binds to ghrelin receptor stimulates the release of growth hormone (GH) from the pituitary gland and enhances appetite.
diarrhea, vomiting, polydipsia, hypersalivation, flatulence, nausea, abdominal discomfort, increased gut sounds, and lethargy.20 Elevated BUN and phosphorus have also been noted
may cause bradycardia transiently in cats
cerenia mech/tox
neurokinin-1 (NK-1) receptor antagonist that acts in the emetic center within the CNS by inhibiting the binding of substance P, which is the key neurotransmitter involved in vomiting.
can cause prolongation of the QT interval because of cardiac potassium channel blockade
caution in hepatic failure - met in liver
ondansetron mech/tox
5-HT3 receptor antagonist. 5-HT3 receptors are found peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone (CRTZ)
GI effects (eg, constipation, diarrhea), sedation, extrapyramidal clinical signs (eg, head shaking), increased liver enzymes, arrhythmias, and hypotension can be possible
humans get headaches
mirtaz mech/tox
potent inhibitor of the 5-HT2, 5-HT3, and histamine (H1) receptors. Antagonism at 5-HT3 receptors accounts for the antinausea and antiemetic effects of the drug, and its action at H1 receptors produces prominent sedative effects. It is a moderate peripheral α1-adrenergic antagonist, a property that may explain the occasional orthostatic hypotension
antidepressant activity of mirtazapine appears to be mediated by antagonism at central presynaptic alpha-2
were vocalization (56%), agitation (31%), vomiting (26.2%), abnormal gait/ataxia (16.7%), restlessness (14.3%), tremors/trembling (14.3%), hypersalivation (13%), tachypnea (11.9%), tachycardia (10.7%), and lethargy
metoclopramide mech/tox
antagonizes dopamine D2 receptors, is a weak inhibitor of serotonin 5-HT3 receptors, and is an agonist of serotonin 5-HT4 receptors. These actions help explain its sedative, central antiemetic, extrapyramidal, and prolactin secretion stimulation effects.
dopamine antagonist. Metoclopramide sensitizes upper GI smooth muscle to the effects of acetylcholine, stimulating motility of the upper GI tract without stimulating gastric, pancreatic, or biliary secretions.
changes in mentation and behavior (eg, motor restlessness, involuntary spasms, aggression, vocalization, hyperactivity, drowsiness, depression). Metoclopramide can increase detrusor muscle contractility and reduce bladder capacity. Adverse effects may be more likely to occur in dogs with renal or hepatic insufficiency
cats - frenzy
cisapride mech and tox
Cisapride is a 5-HT4-receptor agonist that enhances the release of acetylcholine at the myenteric plexus without stimulating nicotinic or muscarinic receptors or inhibiting acetylcholinesterase activity.17,18 Cisapride is also a 5-HT1- and 5-HT3-receptor antagonist of the enteric cholinergic neurons; it is a direct 5-HT2-alpha-receptor agonist on colonic smooth muscle
safe in small animal species at recommended dosages. Occasionally, vomiting, diarrhea, and abdominal discomfort may be noted. may prolong QT
gabapentin
bind to and inactivate presynaptic alpha2delta subunits of the voltage-gated calcium channels. By decreasing calcium influx, the release of excitatory neurotransmitters (eg, substance P, glutamate, norepinephrine) is inhibited. Although gabapentin is structurally related to gamma-aminobutyric acid type A (GABA), it is not a GABA agonist
Gabapentin was associated with an increased rate of pancreatic adenocarcinoma in male rats
Sedation and ataxia
trazodone - mech tox
Trazodone is classified as a 5-HT2A and 5-HT2C antagonist/reuptake inhibitor (SARI) that primarily potentiates serotonin activity in the CNS.
GI disturbances (eg, nausea, vomiting, diarrhea, or colitis), ataxia, and sedation. Tachycardia, increased anxiety, behavior disinhibition, and aggression have also been reported.
Trazodone appears to exert qualitatively different and less pronounced cardiac conduction effects in dogs than do tricyclic antidepressants. In dogs, hepatotoxicity and transient priapism have been reported.
feline pain scale
canine pain scale
equine pain scale
qol scale (these are the principles of palliative and hospice care)
Antibiotic prophylaxis in veterinary cancer chemotherapy: A review and recommendations
- risk of resistance
- w.o abx extra cost to vet owners for febrile neut hospitalization - most dont have insurance
- disruption of the microbiome –may reduce the efficacy of chemotherapy treatment
- prevent infection but induce microbial dysbiosis leading to potential pulmonary complications, reduced responses to chemotherapy, inflammatory colitis, C. difficile and resistant infection
Specific veterinary studies assessing
resistance in chemotherapy patients are not available. However, prior antimicrobial use has been identified as a risk factor for resistance in Staphylococcus pseudointermedius ear and skin isolates in dogs
does antibiotic usage make chemotherapy less effective
disruption of the microbiome –may reduce the efficacy of chemotherapy treatment
A study in mouse models of colon carcinoma and melanoma has revealed that tumour necrosis and immune responses after treatment with platinum chemotherapy were reduced in mice treated with antimicrobials prior to therapy
commensal microbiome (particularly in the small intestine) is essential for an optimal response to chemotherapy. This is likely to be because of the effects such as bacterial translocation and activation of helper T cells, induction of reactive oxygen species and modulation of cell functions in the tumour microenvironment
when to start abx after febrile neutropenia noted
recommend in humans starting antimicrobial therapy within 1 hour of documenting pyrexia and neutropenia
febirle neutropenia occur when after chemo
typically at the expected nadir but
One study found that 40% of febrile neutropenic episodes occurred outside the expected period of neutropenia (the period of prophylaxis in this study) suggesting that timing based on the anticipated neutropenia may not be optimal
SE seen in chemo overdoses
lethargy, anemia, neutropenia, thrombocytopenia, anorexia, diarrhea, nausea, vomiting, ileus, cystitis, mental depression requiring O2, death
all signs lasted an average of 1 week 4-10 days
is filgastrim beneficial in chemo OD
unclear if it works in canines
in an od study - 4/5 dogs who received prophylactic filgastrim still developed neutropenia - gr 3-4
What drugs have been found to overdose small dogs with BSA?
Doxorubicin, cisplatin, carboplatin, melphalan
Plasmapheresis may reverse all side-effects of what chemotherapy overdose
cisplatin and vincristine - maybe all platinums - human lit
both highly nephrotoxic (compromising endogenous clearance) and are highly protein bound with long half-lives, lending themselves to removal via TPE
tumor volume calculation according to human literature
v = l x w^2 x 0.5 ( bc height is hard to measure)
OR
v = 4/3 x 𝜋 x L/2 x w/2 x h/2 ( assumes elliptical shape)
since height is hard to measure use
h = 2/3 (L)
tumor volume according to stelfonta
0.5 x [length (cm) x width (cm) x height (cm)]
volume cannot not exceed 10cm3
how does stelfonta work ?
The active ingredient for tigilanol tiglate injection is a phorbol ester that activates alpha, beta I, beta II, and gamma isoforms of protein kinase C.
oncolysis, stimulation of acute inflammatory response and increased permeability of tumor vasculature
STELFONTA dose volume calculation
0.5 x calculated tumor volume = mL
total dose is not more than 5mL or
0.25mL/kg
Minimum dose 0.1mL.
