Oncology part 2 treatments

Question 1

Neutropenic Fever

Answer 1

AFTER CULTURE IS TAKEN, IV empiric antibiotic therapy should be initiated -

Ceftazidime, Cefipime or Imipenem for antipseudomonal coverage

Aminoglycoside to cover gram – bacteria (Streptomycin, Gentamicin)

Vancomycin to cover MRSA

Question 2

Spinal Cord Compression

Answer 2

High dose IV corticosteroids
Surgical decompression
Radiation

Question 3

Hypercalcemia

Answer 3

Hydration andforced diuresis

Bisphosphonates, such as zoledronic acid or pamidronate IV can also be initiated

2nd - Calcitonin, which blocks bone resorption and also increases urinary calcium excretion by inhibiting renal calcium reabsorption

Hemodialysis may be necessary to provide a definitive treatment

Question 4

Tumor Lysis Syndrome

Answer 4

includes IV hydration and correction of electrolyte abnormalities
May require emergency hemodialysis

don’t forget that you’d see peaked T waves

Question 5

Cardiac Tamponade/Effusion

Answer 5

echo-guided percutaneous pericardiocentesis under local anesthesia

Question 6

SVC Syndrome

Answer 6

Glucocorticoids(such asprednisoneor methylprednisolone) decrease the inflammatory response to tumor invasion and edema surrounding the tumor.

Glucocorticoids are most helpful if the tumor is steroid-responsive, such as lymphomas

Intravascular stenting, chemotherapy and radiation are also effective depending on the tumor type

Question 7

Thromboembolic Event

Answer 7

Anticoagulation should be initiated immediately, unless contraindicated, with heparin full-dose bolus and infusion or LMWH (enoxaparin) 1mg/kg subQ Q12 hours
DOAC = Ex) Xarelto (rivaroxaban) 15 mg po BID for 21 days, followed by 20mg daily is an alternative

Thrombolytic therapy may be necessary with hemodynamic compromise and severe RV failure on echo