Oncologic emergencies Flashcards by Nita Gombakomba

Give 3 examples of short acting opioids

Oxycodone, dilaudid, morphine

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Give three examples of long acting opioids

MS Contin, Oxycontin, Fentanyl Patch

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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)

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What are some of the side effects of opioids

Constipation

Sedation

Itching

Dizziness

Nausea

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How does cancer chemotherapy contribute to vomiting?

Cancer chemotherapy contributes to vomiting via serotonin (thru 5HT receptor), substance P via NK receptor

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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

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What are some patient risk factors for chemotherapy induced vomiting?

Low alcohol consumption

Younger age

Female patient

History of motion sickness

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__ is a cancer drug used to treat testicular cancer that causes severe nausea and vomiting

Cisplatin

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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)

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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)

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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)

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What would you give to treat emesis (I guess the non-delayed type)

Prochlorperazine

Steroids

Hydration

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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)

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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)

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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

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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