Oncologic emergencies Flashcards
Give 3 examples of short acting opioids
Oxycodone, dilaudid, morphine
Give three examples of long acting opioids
MS Contin, Oxycontin, Fentanyl Patch
Why would you want to use a long acting opioid to treat a cancer patient’s pain?
Short acting opioids only give temporary relief so the pt will still be experiencing bouts of pain/oscillations so need to use long acting meds to prevent this (see diagram below)
What are some of the side effects of opioids
Constipation
Sedation
Itching
Dizziness
Nausea
How does cancer chemotherapy contribute to vomiting?
Cancer chemotherapy contributes to vomiting via serotonin (thru 5HT receptor), substance P via NK receptor
What are the factors relating to chemotherapy induced vomiting? (hint: things like dosage and stuff)
Intrinsic emetogenicity of the chemotherapeutic drug
Dose
Route of administration
Rate of infusion
Repeated cycles of chemotherapy
What are some patient risk factors for chemotherapy induced vomiting?
Low alcohol consumption
Younger age
Female patient
History of motion sickness
__ is a cancer drug used to treat testicular cancer that causes severe nausea and vomiting
Cisplatin
Describe the biphasic nature of cisplatin-induced vomiting in cancer patients (at what point in time is emetic intenstiy highest and when is the next phase of emesis seen?)
Emesis peaks with first 24 hours and the second phase is seen between 2-4 days later (around day 3 post taking the drug)
Which 2 types of therapies would you provide to treat emesis induced by a moderate-highly emetic chemo regimen?
Type 3 serotonin antagonist (e.g. ondansetron)
Steroids (e.g. dexamethasone)
For delayed emesis induced by chemotherapy, you would give ___ (class of drugs that’s specifically works at delayed emesis) or steroids/type 3 serotonin antagonist
For delayed emesis induced by chemotherapy, you would give aprepitant - NK1 receptor inhibitor (class of drugs that’s specifically works at delayed emesis) or steroids/type 3 serotonin antagonist
(according to Wikipedia: any drug that ends in -pitant is an NK1 receptor antagonist that works to prevent nausea and vomiting)
What would you give to treat emesis (I guess the non-delayed type)
Prochlorperazine
Steroids
Hydration
Define anorexia and cachexia
Anorexia is a lack of appetite (and subsequent weight) and cachexia is wasting due to chronic illness (also according to wikipedia)
What 3 types of therapy can you give to address anorexia and cachexia from chemo?
Megesterol acetate (Megace) - apparently one side effect is thromboembolism/DVT
Promotility agents (metoclopropamide, Reglan)
THC (Marinol)
At what neutrophil count and temperature is a pt considered to be experiencing neutropenic fever?
What is the first response to treating neutropenic fever?
Absolute neutrophil count of <1000 and temperature >100.4
First step: start on broad spectrum antibiotics
Describe the difference in the pathophysiology of neutropenic fever in solid tumors vs hematologic malignancies
Hematologic malignancies usually are addessed with very myelosuppresive regimens, which explains the neutropenia. With such treatment, there’s high risk of other infections (namely fungal) and mucositis. Also, the duration of neutropenia is longer
Rx for solid tumors isn’t as myelosuppressive, duration is brief and there’s low risk of mucositis
How would you manage/treat neutropenic fever?
Give prophylactic GCSF or GMCSF (but it’s only useful if you start it early)
___ is a common complication of cancer and is defined as a serum sodium of <135mg/dl
Hyponatremia
What 3 volume status conditions can lead to hyponatremia?
What are some symptoms of hyponatremia?
Hypovolemic
Euvolemic
Hypervolemic
**
Symptoms include fatigue, mental status changes, seizures or even no symptoms
Just study this slide
Another common complication of cancer is __ (hint: it’s one of the elements)
Hypercalcemia
Hypercalcemia is ass’d with some cancers, including __ (in the chest), breast cancer, ___ (in WBCs) and non-hodgkins lymphoma
Hypercalcemia is ass’d with some cancers, including non-small cell lung cancer (in the chest), breast cancer, myeloma (in WBCs) and non-hodgkins lymphoma
What are some of the symptoms of hypercalcemia?
Dehydration, abdominal pain, (then the usual fatigue, nausea/vomiting, mental status changes etc)
How would you manage acute hypercalcemia?
IV fluids
Bisphosphonates
Furosemide (Lasix)
Calcitonin
What is tumor lysis syndrome?
Literally just that. Tumors that have a high proliferative index can lyse as they grow and proliferate and that causes all kinds of bad downstream effects
**note that this most commonly happens in hematologic malignancies (acute leukemia and NHL) and sometimes in solid tumors (small cell lung cancer)
Tumor lysis syndrome results from release of __, the consequences of which include renal failure, hyperkalemia and even death
Tumor lysis syndrome results from release of intracellular components e.g. K+, P, and purines (uric acid), the consequences of which include renal failure, hyperkalemia and even death
Prevention of tumor lysis syndrome can be achieved using which drug? What other things can you do to prevent this?
Allopurinol:
Allopurinol is a xanthine oxidase inhibitor (prevents build up of uric acid but doesn’t break it down)
Other options for prevention:
Monitoring electrolytes and levels of intracellular components, hydration, alkalinization
What is the treatment for tumor lysis syndrome?
Besides the same hydration etc, you can use rasburicase
(can also use Kayexelate)
Rasburicase: recombinant urate oxidase (breaks down uric acid)
**pts with G6PD deficiency who get Rasburicase get massive hemolysis**
A cancer patient presents with pain, weakness, paresthesias, ataxia and bladder dysfunction for around 7 weeks. What is on your differential/what are you thinking?
Malignant Spinal Cord Compression
What are potential causes of spinal cord compression?
Metastatic cancer
Herniated disk
Benign bony lesions
Abscess
Others
The most common presenting symptom of malignant spinal cord compression is __
New onset of back pain:
worse with cough/valsalva, awakens patient and may not be presently associated with neurological symptoms (those occur later)
What studies would you order in a case of suspected malignant spinal cord compression?
Predominantly MRI of the enitre spinal cord
How would you treat malignant spinal cord compression?
Steroids
Radiotherapy
Surgery
Chemotherapy
