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Oncology > Management of Cancer SE > Flashcards

Management of Cancer SE Flashcards

1
Q

SE of Anti-Neoplastic Agents

A 
Alopecia
Anorexia
Cardiotoxicity
Constipation
Skin or Cutaneous Responses
Diarrhea
Fatigue
Hemorrhagic cystitis
Hepatotoxicity
Hypersensitivity reactions
Mucositis/Stomatits/ Esophagitis
N/V
Nephrotoxicity
Neurotoxicity
Pulmonary toxicity
Sexual & reproductive dysfunction
Myelosuppression
Anemia
Neutropenia
Thrombocytopenia
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2
Q

Assessment of Alopecia

A

Usually within 2 weeks

Reversible

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3
Q

Education with Alopecia

A

Emotional support

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4
Q

Assessment of Anorexia

A

Dietary history
Weight
Lab values

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5
Q

Education for Anorexia

A

Weekly weights

Small frequent meals

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6
Q

Medications for Treatment of Anorexia

A

Antiemetics
Megesterol (Megace)
Dronabinol (Marinol)
Remeron: Antidepressant

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7
Q

Cardiotoxicity

A

Related to effect of drugs or radiation to cardiac muscle, pericardium

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8
Q

Chronic Cardiotoxicity

A

Cumulative dosing of cardiotoxic drugs

Radiation to large volumes of heart or pericardium

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9
Q

Medications that have Cardiotoxicity

A 
Doxorubicin
Daunorubicin
Mitoxantrone
High dose cyclophosphamide
High dose 5FU
Paclitaxel
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10
Q

Assessment of Cardiotoxicity

A

History of HTN
Smoking
Pre-existing cardiac disease

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11
Q

Collaborative Management of Cardiotoxicity

A 
MUGA scan
Exercise
Diet modification
Dose reduction
EKG
Dexrazoxone (Zinecard)
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12
Q

Education for Cardiotoxicity

A

Inform of possible cardiotoxicity
S/S of CHF
Daily weights
Symptoms management

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13
Q

Pathophysiology of Constipation

A

Result of neurotoxic effects resulting in decreased peristalsis

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14
Q

Assessment of Constipation

A

Patients receiving vinca alkaloids
Hypercalcemia
Opioid pain management
Dehydration

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15
Q

Management of Constipation

A

Bowel program
Exercise
Diet modifications
Laxative & stool softener

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16
Q

Education for Constipation

A

Increasing fluids
Dietary interventions
Establish a bowel program

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17
Q

Assessment of Skin or Cutaneous Responses

A

Rash
Photosensitivity
Hypersensitivity

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18
Q

Education for Skin or Cutaneous Responses

A

Prepare patients for potential changes
Monitor S/S of infection
Avoid heat & vasodilation

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19
Q

Management of Skin or Cutaneous Responses

A

Call Rad Onc to discuss skin care

Call Med Onc to discus medical management

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20
Q

Acral Erythema (Hand-foot syndrome)

A

Painful palms & soles with erythema, desquamation, & ulceration

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21
Q

What is Acral Erythema Commonly Associated with what medications

A

5FU
Capecitabine
Doxirubicin

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22
Q

How to prevent aural erythema?

A

Holding ice packs during infusion

Taking pyridoxine

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23
Q

Pathophysiology of Diarrhea

A

GI mucosa very sensitive to cytotoxic drugs due to high mitotic index

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24
Q

Assessment of Diarrhea

A

Neutropenic status
Bowel elimination patterns
Hydration

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25
Q

Collaborative Management of Diarrhea

A

IV/fluid support
Loperamide
Diphenoxylate

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26
Q

Education for Diarrhea

A

Low residue diet
Fluid requirements
Watch for S/S of dehydration
Perianal care

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27
Q

Pathophysiology of Fatigue

A

Anemia
Changes in sleep patterns
Pain
Psychosocial factors

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28
Q

Assessment of Fatigue

A

Risk factors
Acute vs. chronic
Fatigue level

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29
Q

Collaborative Management of Fatigue

A

Multidisciplinary referrals

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30
Q

Education for Fatigue

A

Setting realistic goals
Energy management
Cause & factors of fatigue

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31
Q

Pathophysiology of Hemorrhagic Cystitis

A

Bladder mucosal irritation from metabolic by-products of drugs

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32
Q

Medications that Cause Hemorrhagic Cystitis

A

Cycclophosphamide
Ifosfamide
High dose methotrexate

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33
Q

Assessment of Hemorrhagic Cystitis

A 
Dysuria
Urinary frequency
Burning
Hematuria
Previous history of pelvic radiation
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34
Q

Collaborative Management of Hemorrhagic Cystitis

A

Lab monitors

PO/IV hydration with diuretics

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35
Q

Education for Hemorrhagic Cystitis

A

Potential for SE to occur
Increase fluid intake
Frequent urination

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36
Q

Pathophysiology Hepatotoxicity

A

Direct toxic effect to liver when drugs are being metabolized

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37
Q

Assessment of Hepatotoxicity

A 
ETOH use
Liver disease
Medication use
Jaundice
Ascites
Hepatomegaly
pain
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38
Q

Collaborative Management of Hepatotoxicity

A

Monitor labs

Limit acetaminophen to

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39
Q

Education for Hepatotoxicity

A

Avoid alcohol

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40
Q

Pathophysiology of Hypersensitivity Reactions

A

Antigen/antibody reaction

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41
Q

Assessment of Hypersensitivity Reactions

A

Clinical manifestations of local or systemic reaction

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42
Q

Collaborative Management of Hypersensitivity Reactions

A 
Test dose
Premedication prior to chemo
Emergency equipment
Steroids
H1 & H2 blockers
Epinephrine
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43
Q

Education for Hypersensitivity Reactions

A

Potential for allergic reactions

S/S of reactions

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44
Q

Pathophysiology of Mucositis/Stomatitis/ Esophagitis

A

Direct effect of drug or radiation on oral mucosa

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45
Q

Common Cancers with Mucositis/Stomatitis/ Esophagitis

A

Leukemia
Lymphoma
H&N Cancers

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46
Q

Assessment of Mucositis/Stomatitis/ Esophagitis

A

Xerostomia
Mucositis
Yeast Infections

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47
Q

Signs/Symptoms of Xerostomia

A

Dysphagia
Plaque formation
Pale, dry oral mucosa
NOT PAINFUL

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48
Q

Signs/Symptoms of Mucositis

A

Erythema
Dequamation
Ulceration
VERY PAINFUL

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49
Q

Signs/Symptoms of Yeast Infections

A

Thrush

Oral or esophageal candidiasis

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50
Q

Collaborative Management of Mucositis/Stomatitis/ Esophagitis

A

Aim is prevention, dental referral, “magic mouthwash”, chlorhexidine (Peridex) rinse

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51
Q

Education with Mucositis/Stomatitis/ Esophagitis

A

Frequent oral hygiene
Use of saline or baking soda rinses QID
Cryotherapy

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52
Q

Grading of Mucositis/Stomatitis

A 
0= no change
1= soreness
2= erythema, ulcers, can eat solids
3= ulcers, liquid diet
4= severe ulcers; no oral intake
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53
Q

Pathophysiology of N/V

A

Stimulation of vagus nerve by release of serotonin
Stimulation of the chemoreceptor trigger zone in the medulla
Stimulation of the true vomiting center

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54
Q

Epidemiology of N/V in Cancer Patients

A

Females > Males

Youth > Elderly

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55
Q

Assessment of N/V

A

Rule out other causes of nausea, hydration status, weight loss, electrolytes

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56
Q

Collaborative Management of N/V

A 
Timely administration of antiemetics
Fluid support
Emotional support
Dietary support
Telephone F/U if treated as outpatient
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57
Q

Education for N/V

A

Patient to notify clinic if symptoms persist >48 hours
Unable to maintain oral intake
Antiemetics around the clock for first 24-72 hours after chemo

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58
Q

Medications for Chemotherapy Induced N/V

A

Palonosetron (Aloxi)
Odansetron (Zofran)
Lorazepam (BZD)
Prochlorperazine (Phenothiazine)

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59
Q

Pathophysiology of Nephrotoxicity

A

Direct cell damage to the kidney

Indirect cell damage by metabolites

60
Q

Common Medications that Lead to Nephrotoxicity

A

Cisplatin

High dose methotrexate

61
Q

Assessment of Nephrotoxicity

A

Age
Renal disease
Nephrotoxic drugs
Lab values

62
Q

Management of Nephrotoxicity

A

Adequate IV hydration

Rescue therapy with dialysis

63
Q

Education for Nephrotoxicity

A

Adequate fluid intake

64
Q

Pathophysiology of Neurotoxicity

A

Direct effect on the nervous system
Metabolic encephalopathy
Intracranial hemorrhage due to coagulopathy or myelosuppression

65
Q

Reasons for Neurotoxicity

A

High dose chemotherapy

Drugs crossing the blood-brain barrier

66
Q

Assessment of Neurotoxicity

A 
Tinnitis
Peripheral neuropathies
Fine motor loss
Numbness
Tingling
Gait distrubances
Changes in mentation
Urinary retention
Constipation
67
Q

Management of Neurotoxicity

A

Avoid extreme temperatures

68
Q

Education for Neurotoxicity

A

S/S of neurotoxicity

Many symptoms reversible if interventions initiated early

69
Q

Pathophysiology of Pulmonary Toxicity

A

Toxic damage to alveoli resulting in pneumonitis & pulmonary fibrosis

70
Q

Chemo Therapy with Pulmonary Toxicity

A

Bleomycin
Busulfan
Radiotherapy

71
Q

Assessment of Pulmonary Toxicity

A

Thorough respiratory assessment

72
Q

Collaborative Management of Pulmonary Toxicity

A

Pulmonary function tests prior to therapy
Treat with corticosteroids
Discontinue therapy

73
Q

Education for Pulmonary Toxicity

A

S/S associated with pulmonary toxicity

Energy conservation techniques

74
Q

Pathophysiology of Sexual & Reproductive Dysfunction

A

Toxic effects on the gametes
Physical SE of chemotherapy
Can be permanent or temporary

75
Q

Assessment of Sexual & Reproductive Dysfunction

A

Early menopause

Sterility

76
Q

Collaborative Management of Sexual & Reproductive Dysfunction

A

Sperm banking

Counseling

77
Q

Education for Sexual & Reproductive Dysfunction

A

Implications of treatment of sexuality

Long term effects

78
Q

Pathophysiology of Myelosuppression

A

Bone marrow highly sensitive to toxic effects of chemotherapy due to high mitotic index
Can be dose-limiting & delay treatment
Anemia, neutropenia, thrombocytopenia, pancytopenia

79
Q

Situations for Myelosuppression

A 
Leukemia
Taxmen use
Alkylating agent use
Antimetabolite use
Etoposide use
Nitrosurea use
80
Q

Pathophysiology of Anemia

A

Changes in the erythrocyte-proliferation pathways

81
Q

Assessment of Anemia

A 
Dyspnea
Fatigue
Concomitant radiation
Poor nutritional status
Elderly
Hx of renal or hepatic impairment
82
Q

Collaborative Management of Anemia

A

CBC
RBC transfusions as needed
Iron supplements
Oxygen therapy

83
Q

Education of Anemia

A

S/S of anemia

Change positions slowly to prevent falls & injury

84
Q

Pathophysiology of Neutropenia

A

ANC

85
Q

Assessment of Neutropenia

A

Age
Malnutrition
Prior chemotherapy or radiation
S/S of infection

86
Q

Collaborative Management of Neutropenia

A 
CBC
Neutropenic fever
recommendations
Filgrastim
Pegfilgrastim
87
Q

Education for Neutropenia

A

S/S of infection
Meticulous
Hygiene
Daily temps

88
Q

Who always gets admitted to the hospital for cancer patients?

A

Anyone with a fever

89
Q

Pathophysiology of Thrombocytopenia

A

Bone marrow suppression decreases lately progression

90
Q

Assessment of Thrombocytopenia

A

Petechiae
Bruising
Hemorrhage
S/S of intracranial bleeding

91
Q

Collaborative Management of Thrombocytopenia

A

Platelet counts
Platelet transfusion
Thombocytopenic precautions

92
Q

Thrombocytopenic Precautions

A

Electric razor
No suppositories or douches
No dental flossing
No injections

93
Q

Education for Thrombocytopenia Patients

A

S/S of bleeding to report

94
Q

Radiation SE

A 
N/V
Trouble swallowing
Fatigue
Decrease in platelets & lymphocytes
Erythema
Alopecia
Fibrin plaquing
Urinary & bladder changes
Visceral changes
Irreversible damage to gametes
Sterility
Suppress osteoblast activity
Decrease number of osteocytes
95
Q

Skin SE of Radiation

A

Erythema

Alopecia

96
Q

Mucous Membranes SE of Radiation

A 
Fibrin plaquing
Urinary & bladder changes
Visceral changes (secretory)
97
Q

Reproductive Organ SE of Radiation

A

Irreversible damage to gametes

Sterility

98
Q

Bone SE of Radiation

A

Suppress osteoblast activity

Decrease number of osteocytes

99
Q

Nonverbal Signs of Pain

A 
HTN
Tachycardia
Diaphroresis
Agitation or confusion
Apathy, inactivity, or irritability
Refusal to eat
Protect painful part
Show facial grimacing
100
Q

Pain Measurement Tools

A

Pain scale
McGill Pain Questionnaire
Memorial pain assessment card

101
Q

What type of pain is caused by invasion of bone by the tumor?

A

Deep, achy, unrelenting pain

102
Q

What type of pain is caused by nerve compression?

A

Neuropathic pain
Lightening bolts
Stabbing
Pins & needles

103
Q

Pain Complications of Treatment

A

Radiation fibrosis
Chemotherapy-induced neuropathy
Postoperative surgical pain

104
Q

Types of Pain

A

Somatic
Visceral
Neuropathic

105
Q

Define Somatic Pain

A

Potential or real injury to tissues & is type pain that we treat

106
Q

Description of Somatic Pain

A

Tender & localized to site of injury
Constant
Sometimes throbbing or achy

107
Q

What is the most common cause of somatic pain in patients with cancer?

A

Bone mets

108
Q

Define Visceral Pain

A

Poorly localized & often referred to a distant site which may be tender

109
Q

Description of Visceral Pain

A

Less constant than somatic pain

Dull, colicky waves

110
Q

Causes of Visceral Pain

A

Activation of pain receptors resulting from infiltration, compression, extension, or stretching of the thoracic, abdominal, or pelvic viscera

111
Q

Common Causes of Visceral Pain

A

Pancreatic CA

Mets in the abdomen

112
Q

Define Neuropathic Pain

A

Prolonged, severe, burning or squeezing pain

113
Q

What may accompany neuropathic pain?

A

S/S of autonomic instability

114
Q

Cause of Neuropathic Pain

A

Injury to the nervous system

115
Q

Pain Sites

A 
Bone pain
Back pain
Headache
Facial pain
Abdominal pain
Pelvic pain
Post-op pain
Phantom pain
More than 1 site
116
Q

Factors that Influence the Development of Cancer pain

A

Cancer type & site

Presence or absence of mets

117
Q

Most Frequent Causes of Pain

A

Visceral involvement
Bone metastases
Soft tissue invasion
Nerve/plexus pressure or infiltration

118
Q

Treatment Goals of Pain

A

Diminish pain & associated emotional stress
Increase physical, social, vocational, & recreational involvement
Optimize health
Improve psychological well being
Improve coping ability
Reduce dependence on health care system

119
Q

Pain Management

A

Use of pharmacologic agents as well as analgesic adjuvants
Physical & nonpharmacologic approaches (treating CA or how patient reacts to pain)
Neurosurgical & anesthetic interventional procedures

120
Q

Step Wise Approach to Pain Management

A

Non-opioid + adjuvant
Opioid (hydrocodone) + non-opioid + adjuvant
Opioid (oxycodone) + non-opioid + adjuvant

121
Q

What medication should you not prescribe in cancer patients?

A

Codeine

This is due to varying responses to medication

122
Q

Step 1 in Pain Management

A

NSAIDS and Acetaminophen

Around the clock dosing

123
Q

Why are opioids widely used in cancer patients for pain?

A

Reliability
Safety
Multiple routes of administration
Ease of titration

124
Q

Choice of Opioids

A

Short half-life & PRN to start

Sustained release can be added

125
Q

Which opioid may have a dual MOA?

A

Tramadol

126
Q

MOA of Tramadol

A

Inhibits neuronal re-uptake of serotonin & norepinephrine

127
Q

What medications can be used to provide an opioid-sparing effect?

A

Antidepressants
Anticonvulsants
Local anesthetics

128
Q

TCAs for Pain Management in Cancer Patients

A

Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Imipramine (Tofranil)
Desipramine (Norpramin)

129
Q

Anticonvulsants for Pain Management in Cancer Patients

A

Carbamazepine (Tegratol)
Clonazepam (Klonopin)
Gabapentin (Neurontin)

130
Q

MD Anderson Protocol for Mild to Moderate Pain

A

Non-opions

131
Q

MD Anderson Protocol for Moderate to Severe Pain

A

Opioids: morphine, hydromorphone, oxycodone, hydrocodone, codeine, fentanyl, & methadone

132
Q

MD Anderson Protocol for Tingling & Burning Pain

A

Antidepressants: amitriptyline, imipramine, doxepin
Antiepileptics: gabapentin

133
Q

MD Anderson Protocol for Pain Caused by Swelling

A

Prednisone

Dexamethasone

134
Q

Most Commonly Used Opioids in Management of Cancer Pains

A

Morphine

Fentanyl

135
Q

Medications to Avoid in Management of Cancer Pain

A

Codeine

Meperidine

136
Q

What can contribute to depression in cancer patients?

A

Uncontrolled pain
SE of opioids
Fear of pain

137
Q

Anesthetic Interventional Approaches to Pain Management

A 
Nerve blocks: celiac plexus, superior hypogastric plexus
Myofascial injections
Neuroma injections
Spinal cord stimulation
Intrathecal & epidural injections
138
Q

Complementary & Alternative Pain Management

A 
Biofeedback
Breathing & relaxation exercised
Distraction
Heat or cold
Hyponosis
Imagery
Massage, pressure & vibration
Transcutaneous electrical nerve stimulations (TENS)
Acupuncture
Coenzyme Q10
Self-help & support groups
139
Q

Define Biofeedback

A

Technique that makes the patient aware of bodily process normally through to be involuntary and gain conscious control over these processes which can influence level of pain (blood pressure, skin temp, HR)

140
Q

Breathing & Relaxation Exercises for Pain Management

A

Focus attention on performing a specific task instead of on pain

141
Q

Distraction in Pain Management

A

Method to divert patient’s attention to a more pleasant event, object, or situation

142
Q

Heat or Cold in Pain Management

A

Temperature to facilitate pain control with ice or heating pad

143
Q

Hypnosis in Pain Management

A

Focused state of consciousness that allows the patient to better process information

144
Q

Imagery in Pain Management

A

Soothing, positive mental images that allow the patient to relax

145
Q

Massage, Pressure, & Vibration in Pain Management

A

Physical stimulation of muscles or nerves can facilitate relaxation & relieve painful muscle spasms or contractions

146
Q

Transcutaneous Electrical Nerve Stimulation (TENS) in Pain Management

A

Mild electric current is applied to the skin at the site of pain

Oncology (11 decks)

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