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703 > Oncologic Emergencies > Flashcards

Oncologic Emergencies Flashcards

1
Q

In which groups of patients is incidence of hypercalcemia most common in?

A
  • NSC lung cancer
  • Breast cancer
  • Multiple myeloma
  • Squamous-cell cancers of the head and neck
  • Urothelial carcinomas
  • Ovarian cancers
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2
Q

What corrected calcium level defines mild hypercalcemia?

A

10.5 to 11.9 mg/dL

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3
Q

What corrected calcium level defines moderate hypercalcemia?

A

12 to 13.9 mg/dL

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4
Q

What corrected calcium level defines severe hypercalcemia?

A

14+ mg/dL

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5
Q

What other laboratory values should be tested for in hypercalcemia?

A
  • Serum phosphorous
  • PTH
  • Vitamin D
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6
Q

What is the formula for corrected calcium?

A

0.8*(4 - albumin) + serum calcium

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7
Q

What are some S/S of hypercalcemia?

A
  • AKI
  • N/V
  • Lethargy/muscle weakness
  • Shortened QT interval
  • Arrhythmias
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8
Q

Which etiology accounts for most cases of hypercalcemia?

A

Humoral (PTH-related peptide increased)
- increased calcium tubular reabsorption and phosphorus excretion

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9
Q

What are the rare causes of hypercalcemia?

A
  • Vitamin D toxicity
  • Ectopic PTH production by tumor
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10
Q

What treatment do we use to increase calcium excretion?

A

NS bolus of 1-2L, followed by 200-500 mL/hr infusion
Furosemide 20-40 mg (fluid overloaded or HF patients)

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11
Q

What treatments do we use to inhibit bone resorption?

A
  • Pamidronate (bisphosphonate)
  • Zoledronate (bisphosphonate)
  • Denosumab (RANKL-RANK binding inhibitor)
  • Calcitonin (direct inhibition and increased Ca2+ excretion)
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12
Q

What dose of pamidronate should we give to a patient with a corrected calcium >12?

A

90 mg IV

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13
Q

What dose of zoledronic acid should we give to a patient with a corrected calcium >12?

A

4 mg IV

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14
Q

Should you use bisphosphonates in renal impairment?

A

NO

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15
Q

How many days do we wait before repeating bisphosphonate doses for hypercalcemia?

A

7 days

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16
Q

T/F: Denosumab should be avoided in renal impairment

A

FALSE

17
Q

Why do we limit calcitonin treatment to 24-48 hours?

A

Tachyphylaxis

18
Q

What possible reserved options do we have if main therapies fail for hypercalcemia?

A
  • Steroids
  • Cinacalcet
  • Dialysis
19
Q

What labs are characteristic of tumor lysis syndrome?

A

↑ K
↑ Uric acid
↑ Phosphate

↓ Calcium

20
Q

What are risk factors for TLS?

A
  • High uric acid at baseline
  • Nephropathy
  • Hypotension
  • HF
21
Q

T/F: Low WBC leads to a higher risk of TLS

A

FALSE: High WBC is associated with TLS risk

22
Q

What is the treatment approach to TLS?

A
  • Monitor labs q4-6 hours
  • NS 150-300 mL/hr (NOT SODIUM BICARB)
  • Allopurinol / Rasburicase
23
Q

Which uric acid treatment comes first in high risk TLS patients?

A

Rasburicase

24
Q

Which uric acid treatment comes first in intermediate risk TLS patients?

A

Allopurinol

25
Q

Generally allopurinol has no renal considerations unless what is present?

A

CKD

26
Q

How do we treat hyperphosphatemia?

A

IV fluids + diuretics
Maybe phosphate binders

27
Q

T/F: We do not always correct hypocalcemia

A

TRUE: usually resolves when hyperphosphatemia is addressed
Correction may introduce complications and hypercalcemia

28
Q

What are risk factors for febrile neutropenia?

A
  • Age >65
  • Previous chemo or radiation
  • Pre-existing neutropenia or bone marrow tumor
  • Gender
  • Low BMI
  • Poor performance status
  • Comorbidities
  • Genetic polymorphisms
29
Q

How is neutropenia defined?

A

ANC < 500
OR
ANC <1000, expected to drop below 500 within 48 hours

30
Q

How is fever defined?

A

Temperature >38.3 C
OR
Temperature >38 for over 1 hour

31
Q

When do we give prophylaxis for LOW risk neutropenia?

A

Previous HSV infection

32
Q

Which prophylaxis treatments should we consider/give for high or intermediate risk patients?

A
  • Bacterial
  • Fungal
  • Viral
  • PJP
33
Q

A MASCC score of at least WHAT indicates a low infection risk in febrile neutropenia?

A

21

34
Q

What bacterial prophylaxis should be given to a low risk patient with febrile neutropenia?

A

Fluoroquinolone

Cefepime if they’re already taking a quinolone

35
Q

What bacterial prophylaxis should be given to a high risk patient with febrile neutropenia?

A

Empiric IV options
- Pip-tazo
- Cefepime
- Meropenem

36
Q

When do we consider MRSA coverage?

A
  • Catheter-related infections
  • SSTI
  • Pneumonia
  • Mucositis
  • Hemodynamic insufficiency or sepsis
37
Q

When do we give fungal coverage in patients with febrile neutropenia?

A
  • Hematologic malignancies
  • Hemodynamically unstable
  • Signs of sepsis
  • 7+ days of febrile neutropenia
38
Q

What are the three ways we can treat hypercalcemia (mechanisms)?

A
  • Increasing calcium excretion
  • Decreasing bone resorption
  • Reduced intestinal absorption of calcium

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