Oncology III Flashcards
1
Q
What the patient tells us
A
- About themselves
- About there mental state
- Co-morbidities
- Medication
- Support
2
Q
Toxicity the questions we should be asking
A
- Duration vs Severity
- Single vs Multiple
- Visible vs Invisible
- Preventable vs Manageable
3
Q
Signs and symptoms of anaphylaxis
A
4
Q
Anaphylactic reaction pathway
A
- ABCDE (Airway Breathing Circulation Disability Exposure) =>
- Diagnosis: Acute onset of illness, life-threatening airway/breathing/circulation problems =>
- Call for help: Lie patient flat, raise patient legs =>
- Adernaline =>
- When skills and equipment available
- Establish airway, high O2 flow, IV fluid challenge, Chlorphenamine, hydrocortisone
- MONITOR: Pulse, ECG, BP
5
Q
Extravasation is
A
- The leakage of one drug from its intended compartment of delivery into one or more adjacent compartments
- It has a number of euphemisms- infiltration, tissuing, displacement- but at the end of the day they are all the same injury
- It is a complex interaction of factors
- It is a whole spectrum of reactions from a pre-extravasation syndrome to a complete necrotic breakdown of tissue
- It is an oncological parenteral therapy emergency
6
Q
Difficult to diagnose, varied and unpredictable development & outcome
A
7
Q
Factors known to be involved
A
- Patient
- Practical
- Personnel
- Pharmacological
- An individual extravasation injury will be a mix of all of the above
- Some factors are causative of injuries whilst others are contributory too it
8
Q
Basis of treatment
A
- ALWAYS
- Aspirate
- Palliate the immediate symptoms
- THEN
- Localise and Neutralise- followed by
- Dilute and spread
- For established or missed extravasations
- treat as for other ulcerated tissue- de-bride and granulate
9
Q
There should be a national protocol for the treatment of extravasation, and a standard approach to antidotes
A
10
Q
Chemotherapy-induced N&V (CINV)
A
- Can lead to serious complications
- Dehydration
- Malnutrition
- Electrolyte disturbance
- May result in delay, dose reduction or discontinuation of SACT
- Effective management is an important part of patient care
11
Q
Risk factors
A
- Gender
- Age
- Chemotherapy (previous treatments)
- History of lifestyle
12
Q
Emetogenic risk with SACT
A
- CINV is complex
- Main risk factors
- SACT emetogenic potential
- SACT categorised for emetic risk
- Minimal (0-10%)
- Low (10-30%)
- Moderate (>30-90%)
- High (90%)
13
Q
Types of N+V associated with chemotherapy
A
- Acute vomiting
- Occurs within 24 hrs of SACT, peaks after 5-6 hours
- Delayed N&V
- >24hrs post SACT, lasts 3-7 days
- Anticipatory N&V
- Conditioned response; associated poor control previously
- Breakthrough N&V
- CINV despite prophylaxis
- Refractory vomiting
- CINV despite interventions, recurs in subsequent cycles
14
Q
Antiemetic prophylaxis for chemotherapy-induced N&V
A
15
Q
Emetic reflex
Neurotransmitters: targeting key pathways
A
- DA
- Histamine
- 5-HT
- Endorphins
- Substance P
- GABA
- Cannabinoids
- ACh