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
2
Q
Assessment of Alopecia
A
Usually within 2 weeks
Reversible
3
Q
Education with Alopecia
A
Emotional support
4
Q
Assessment of Anorexia
A
Dietary history
Weight
Lab values
5
Q
Education for Anorexia
A
Weekly weights
Small frequent meals
6
Q
Medications for Treatment of Anorexia
A
Antiemetics
Megesterol (Megace)
Dronabinol (Marinol)
Remeron: Antidepressant
7
Q
Cardiotoxicity
A
Related to effect of drugs or radiation to cardiac muscle, pericardium
8
Q
Chronic Cardiotoxicity
A
Cumulative dosing of cardiotoxic drugs
Radiation to large volumes of heart or pericardium
9
Q
Medications that have Cardiotoxicity
A
Doxorubicin Daunorubicin Mitoxantrone High dose cyclophosphamide High dose 5FU Paclitaxel
10
Q
Assessment of Cardiotoxicity
A
History of HTN
Smoking
Pre-existing cardiac disease
11
Q
Collaborative Management of Cardiotoxicity
A
MUGA scan Exercise Diet modification Dose reduction EKG Dexrazoxone (Zinecard)
12
Q
Education for Cardiotoxicity
A
Inform of possible cardiotoxicity
S/S of CHF
Daily weights
Symptoms management
13
Q
Pathophysiology of Constipation
A
Result of neurotoxic effects resulting in decreased peristalsis
14
Q
Assessment of Constipation
A
Patients receiving vinca alkaloids
Hypercalcemia
Opioid pain management
Dehydration
15
Q
Management of Constipation
A
Bowel program
Exercise
Diet modifications
Laxative & stool softener
16
Q
Education for Constipation
A
Increasing fluids
Dietary interventions
Establish a bowel program
17
Q
Assessment of Skin or Cutaneous Responses
A
Rash
Photosensitivity
Hypersensitivity
18
Q
Education for Skin or Cutaneous Responses
A
Prepare patients for potential changes
Monitor S/S of infection
Avoid heat & vasodilation
19
Q
Management of Skin or Cutaneous Responses
A
Call Rad Onc to discuss skin care
Call Med Onc to discus medical management
20
Q
Acral Erythema (Hand-foot syndrome)
A
Painful palms & soles with erythema, desquamation, & ulceration
21
Q
What is Acral Erythema Commonly Associated with what medications
A
5FU
Capecitabine
Doxirubicin
22
Q
How to prevent aural erythema?
A
Holding ice packs during infusion
Taking pyridoxine
23
Q
Pathophysiology of Diarrhea
A
GI mucosa very sensitive to cytotoxic drugs due to high mitotic index
24
Q
Assessment of Diarrhea
A
Neutropenic status
Bowel elimination patterns
Hydration
25
Collaborative Management of Diarrhea
IV/fluid support
Loperamide
Diphenoxylate
26
Education for Diarrhea
Low residue diet
Fluid requirements
Watch for S/S of dehydration
Perianal care
27
Pathophysiology of Fatigue
Anemia
Changes in sleep patterns
Pain
Psychosocial factors
28
Assessment of Fatigue
Risk factors
Acute vs. chronic
Fatigue level
29
Collaborative Management of Fatigue
Multidisciplinary referrals
30
Education for Fatigue
Setting realistic goals
Energy management
Cause & factors of fatigue
31
Pathophysiology of Hemorrhagic Cystitis
Bladder mucosal irritation from metabolic by-products of drugs
32
Medications that Cause Hemorrhagic Cystitis
Cycclophosphamide
Ifosfamide
High dose methotrexate
33
Assessment of Hemorrhagic Cystitis
```
Dysuria
Urinary frequency
Burning
Hematuria
Previous history of pelvic radiation
```
34
Collaborative Management of Hemorrhagic Cystitis
Lab monitors
| PO/IV hydration with diuretics
35
Education for Hemorrhagic Cystitis
Potential for SE to occur
Increase fluid intake
Frequent urination
36
Pathophysiology Hepatotoxicity
Direct toxic effect to liver when drugs are being metabolized
37
Assessment of Hepatotoxicity
```
ETOH use
Liver disease
Medication use
Jaundice
Ascites
Hepatomegaly
pain
```
38
Collaborative Management of Hepatotoxicity
Monitor labs
| Limit acetaminophen to
39
Education for Hepatotoxicity
Avoid alcohol
40
Pathophysiology of Hypersensitivity Reactions
Antigen/antibody reaction
41
Assessment of Hypersensitivity Reactions
Clinical manifestations of local or systemic reaction
42
Collaborative Management of Hypersensitivity Reactions
```
Test dose
Premedication prior to chemo
Emergency equipment
Steroids
H1 & H2 blockers
Epinephrine
```
43
Education for Hypersensitivity Reactions
Potential for allergic reactions
| S/S of reactions
44
Pathophysiology of Mucositis/Stomatitis/ Esophagitis
Direct effect of drug or radiation on oral mucosa
45
Common Cancers with Mucositis/Stomatitis/ Esophagitis
Leukemia
Lymphoma
H&N Cancers
46
Assessment of Mucositis/Stomatitis/ Esophagitis
Xerostomia
Mucositis
Yeast Infections
47
Signs/Symptoms of Xerostomia
Dysphagia
Plaque formation
Pale, dry oral mucosa
NOT PAINFUL
48
Signs/Symptoms of Mucositis
Erythema
Dequamation
Ulceration
VERY PAINFUL
49
Signs/Symptoms of Yeast Infections
Thrush
| Oral or esophageal candidiasis
50
Collaborative Management of Mucositis/Stomatitis/ Esophagitis
Aim is prevention, dental referral, "magic mouthwash", chlorhexidine (Peridex) rinse
51
Education with Mucositis/Stomatitis/ Esophagitis
Frequent oral hygiene
Use of saline or baking soda rinses QID
Cryotherapy
52
Grading of Mucositis/Stomatitis
```
0= no change
1= soreness
2= erythema, ulcers, can eat solids
3= ulcers, liquid diet
4= severe ulcers; no oral intake
```
53
Pathophysiology of N/V
Stimulation of vagus nerve by release of serotonin
Stimulation of the chemoreceptor trigger zone in the medulla
Stimulation of the true vomiting center
54
Epidemiology of N/V in Cancer Patients
Females > Males
| Youth > Elderly
55
Assessment of N/V
Rule out other causes of nausea, hydration status, weight loss, electrolytes
56
Collaborative Management of N/V
```
Timely administration of antiemetics
Fluid support
Emotional support
Dietary support
Telephone F/U if treated as outpatient
```
57
Education for N/V
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
58
Medications for Chemotherapy Induced N/V
Palonosetron (Aloxi)
Odansetron (Zofran)
Lorazepam (BZD)
Prochlorperazine (Phenothiazine)
59
Pathophysiology of Nephrotoxicity
Direct cell damage to the kidney
| Indirect cell damage by metabolites
60
Common Medications that Lead to Nephrotoxicity
Cisplatin
| High dose methotrexate
61
Assessment of Nephrotoxicity
Age
Renal disease
Nephrotoxic drugs
Lab values
62
Management of Nephrotoxicity
Adequate IV hydration
| Rescue therapy with dialysis
63
Education for Nephrotoxicity
Adequate fluid intake
64
Pathophysiology of Neurotoxicity
Direct effect on the nervous system
Metabolic encephalopathy
Intracranial hemorrhage due to coagulopathy or myelosuppression
65
Reasons for Neurotoxicity
High dose chemotherapy
| Drugs crossing the blood-brain barrier
66
Assessment of Neurotoxicity
```
Tinnitis
Peripheral neuropathies
Fine motor loss
Numbness
Tingling
Gait distrubances
Changes in mentation
Urinary retention
Constipation
```
67
Management of Neurotoxicity
Avoid extreme temperatures
68
Education for Neurotoxicity
S/S of neurotoxicity
| Many symptoms reversible if interventions initiated early
69
Pathophysiology of Pulmonary Toxicity
Toxic damage to alveoli resulting in pneumonitis & pulmonary fibrosis
70
Chemo Therapy with Pulmonary Toxicity
Bleomycin
Busulfan
Radiotherapy
71
Assessment of Pulmonary Toxicity
Thorough respiratory assessment
72
Collaborative Management of Pulmonary Toxicity
Pulmonary function tests prior to therapy
Treat with corticosteroids
Discontinue therapy
73
Education for Pulmonary Toxicity
S/S associated with pulmonary toxicity
| Energy conservation techniques
74
Pathophysiology of Sexual & Reproductive Dysfunction
Toxic effects on the gametes
Physical SE of chemotherapy
Can be permanent or temporary
75
Assessment of Sexual & Reproductive Dysfunction
Early menopause
| Sterility
76
Collaborative Management of Sexual & Reproductive Dysfunction
Sperm banking
| Counseling
77
Education for Sexual & Reproductive Dysfunction
Implications of treatment of sexuality
| Long term effects
78
Pathophysiology of Myelosuppression
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
Situations for Myelosuppression
```
Leukemia
Taxmen use
Alkylating agent use
Antimetabolite use
Etoposide use
Nitrosurea use
```
80
Pathophysiology of Anemia
Changes in the erythrocyte-proliferation pathways
81
Assessment of Anemia
```
Dyspnea
Fatigue
Concomitant radiation
Poor nutritional status
Elderly
Hx of renal or hepatic impairment
```
82
Collaborative Management of Anemia
CBC
RBC transfusions as needed
Iron supplements
Oxygen therapy
83
Education of Anemia
S/S of anemia
| Change positions slowly to prevent falls & injury
84
Pathophysiology of Neutropenia
ANC
85
Assessment of Neutropenia
Age
Malnutrition
Prior chemotherapy or radiation
S/S of infection
86
Collaborative Management of Neutropenia
```
CBC
Neutropenic fever
recommendations
Filgrastim
Pegfilgrastim
```
87
Education for Neutropenia
S/S of infection
Meticulous
Hygiene
Daily temps
88
Who always gets admitted to the hospital for cancer patients?
Anyone with a fever
89
Pathophysiology of Thrombocytopenia
Bone marrow suppression decreases lately progression
90
Assessment of Thrombocytopenia
Petechiae
Bruising
Hemorrhage
S/S of intracranial bleeding
91
Collaborative Management of Thrombocytopenia
Platelet counts
Platelet transfusion
Thombocytopenic precautions
92
Thrombocytopenic Precautions
Electric razor
No suppositories or douches
No dental flossing
No injections
93
Education for Thrombocytopenia Patients
S/S of bleeding to report
94
Radiation SE
```
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
Skin SE of Radiation
Erythema
| Alopecia
96
Mucous Membranes SE of Radiation
```
Fibrin plaquing
Urinary & bladder changes
Visceral changes (secretory)
```
97
Reproductive Organ SE of Radiation
Irreversible damage to gametes
| Sterility
98
Bone SE of Radiation
Suppress osteoblast activity
| Decrease number of osteocytes
99
Nonverbal Signs of Pain
```
HTN
Tachycardia
Diaphroresis
Agitation or confusion
Apathy, inactivity, or irritability
Refusal to eat
Protect painful part
Show facial grimacing
```
100
Pain Measurement Tools
Pain scale
McGill Pain Questionnaire
Memorial pain assessment card
101
What type of pain is caused by invasion of bone by the tumor?
Deep, achy, unrelenting pain
102
What type of pain is caused by nerve compression?
Neuropathic pain
Lightening bolts
Stabbing
Pins & needles
103
Pain Complications of Treatment
Radiation fibrosis
Chemotherapy-induced neuropathy
Postoperative surgical pain
104
Types of Pain
Somatic
Visceral
Neuropathic
105
Define Somatic Pain
Potential or real injury to tissues & is type pain that we treat
106
Description of Somatic Pain
Tender & localized to site of injury
Constant
Sometimes throbbing or achy
107
What is the most common cause of somatic pain in patients with cancer?
Bone mets
108
Define Visceral Pain
Poorly localized & often referred to a distant site which may be tender
109
Description of Visceral Pain
Less constant than somatic pain
| Dull, colicky waves
110
Causes of Visceral Pain
Activation of pain receptors resulting from infiltration, compression, extension, or stretching of the thoracic, abdominal, or pelvic viscera
111
Common Causes of Visceral Pain
Pancreatic CA
| Mets in the abdomen
112
Define Neuropathic Pain
Prolonged, severe, burning or squeezing pain
113
What may accompany neuropathic pain?
S/S of autonomic instability
114
Cause of Neuropathic Pain
Injury to the nervous system
115
Pain Sites
```
Bone pain
Back pain
Headache
Facial pain
Abdominal pain
Pelvic pain
Post-op pain
Phantom pain
More than 1 site
```
116
Factors that Influence the Development of Cancer pain
Cancer type & site
| Presence or absence of mets
117
Most Frequent Causes of Pain
Visceral involvement
Bone metastases
Soft tissue invasion
Nerve/plexus pressure or infiltration
118
Treatment Goals of Pain
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
Pain Management
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
Step Wise Approach to Pain Management
Non-opioid + adjuvant
Opioid (hydrocodone) + non-opioid + adjuvant
Opioid (oxycodone) + non-opioid + adjuvant
121
What medication should you not prescribe in cancer patients?
Codeine
| This is due to varying responses to medication
122
Step 1 in Pain Management
NSAIDS and Acetaminophen
| Around the clock dosing
123
Why are opioids widely used in cancer patients for pain?
Reliability
Safety
Multiple routes of administration
Ease of titration
124
Choice of Opioids
Short half-life & PRN to start
| Sustained release can be added
125
Which opioid may have a dual MOA?
Tramadol
126
MOA of Tramadol
Inhibits neuronal re-uptake of serotonin & norepinephrine
127
What medications can be used to provide an opioid-sparing effect?
Antidepressants
Anticonvulsants
Local anesthetics
128
TCAs for Pain Management in Cancer Patients
Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Imipramine (Tofranil)
Desipramine (Norpramin)
129
Anticonvulsants for Pain Management in Cancer Patients
Carbamazepine (Tegratol)
Clonazepam (Klonopin)
Gabapentin (Neurontin)
130
MD Anderson Protocol for Mild to Moderate Pain
Non-opions
131
MD Anderson Protocol for Moderate to Severe Pain
Opioids: morphine, hydromorphone, oxycodone, hydrocodone, codeine, fentanyl, & methadone
132
MD Anderson Protocol for Tingling & Burning Pain
Antidepressants: amitriptyline, imipramine, doxepin
Antiepileptics: gabapentin
133
MD Anderson Protocol for Pain Caused by Swelling
Prednisone
| Dexamethasone
134
Most Commonly Used Opioids in Management of Cancer Pains
Morphine
| Fentanyl
135
Medications to Avoid in Management of Cancer Pain
Codeine
| Meperidine
136
What can contribute to depression in cancer patients?
Uncontrolled pain
SE of opioids
Fear of pain
137
Anesthetic Interventional Approaches to Pain Management
```
Nerve blocks: celiac plexus, superior hypogastric plexus
Myofascial injections
Neuroma injections
Spinal cord stimulation
Intrathecal & epidural injections
```
138
Complementary & Alternative Pain Management
```
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
Define Biofeedback
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
Breathing & Relaxation Exercises for Pain Management
Focus attention on performing a specific task instead of on pain
141
Distraction in Pain Management
Method to divert patient's attention to a more pleasant event, object, or situation
142
Heat or Cold in Pain Management
Temperature to facilitate pain control with ice or heating pad
143
Hypnosis in Pain Management
Focused state of consciousness that allows the patient to better process information
144
Imagery in Pain Management
Soothing, positive mental images that allow the patient to relax
145
Massage, Pressure, & Vibration in Pain Management
Physical stimulation of muscles or nerves can facilitate relaxation & relieve painful muscle spasms or contractions
146
Transcutaneous Electrical Nerve Stimulation (TENS) in Pain Management
Mild electric current is applied to the skin at the site of pain
