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Phar 509 > Select Oncological Emergencies and Bone Metastases > Flashcards

Select Oncological Emergencies and Bone Metastases Flashcards

1
Q

What is tumor lysis syndrome

A

Rapid breakdown of cancer cells releases intracellular contents, contents are released too quickly for the body to remove them, causing metabolic abnormalities

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2
Q

What changes happen to electrolytes and other contents due to tumor lysis syndrome

A

Increased uric acid, increased potassium, increased phosphate, decreased calcium

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3
Q

What type of cancer origins are most likley to have tumor lysis syndrome

A

Hematological malignancies: lymphoma and leukemia

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4
Q

What are complications of TLS and what causes them

A

Hyperkalemia: release of intracellular potassium
Acute Renal Failure: DNA coverted to and end product of uric acid crystallize in the kidney, High phosphorous precipitates with calcium

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5
Q

What are the two types of ways TLS is categorized

A

Laboratory and clinical

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6
Q

What are the lab values signifying TLS

A

Uric acid: greater than 8 mg/dL
Potassium: greater than 6 mEq/dL
Phosphorous: greater than 4.5 mg/dL
Calcium: less than 7 mg/dL

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7
Q

T/F: Besides the distinct laboratory values a 50% increase in baseline uric acid, potasssium and phosphorous with a 50% decrease in calcium can also identify TLS

A

False: A 25% increase in uric acid, phosphorous, and potassium and a 25% decrease in calcium can also determine if TLS is present

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8
Q

What is the key fact for defining TLS

A

GREATER THAN OR EQUAL TO 2 of the metabolic abnormalities within 3 DAYS BEFORE OR 7 DAYS AFTER INITIATION of treatment

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9
Q

What is clinical TLS

A

Laboratory TLS with any of the following:

Creatinine greater than 1.5 the upper limit. cardiac arrhythmia, seizure, sudden death

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10
Q

What is the prime enzyme for converting DNA to uric acid, what pH does the urine need to be to remove the uric acid

A

Xanthine oxidase, 5

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11
Q

What are cancer related risk factors for TLS

A

Bulky tumors (large tumor mass, organ infiltration, bone marrow involvement), High LDH, Chemosensitive Tumors (Burkitt lymphoma, lymphoblastic lymphoma, acute leukemias)

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12
Q

What are patient related risk factors for TLS

A

Gout, chronic renal insufficiency, hypertension

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13
Q

What is the patient presentation for TLS

A

Hyperuricemia, dehydration, diminished urine output, acute renal insufficiency, acidic urine

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14
Q

What drug can inhibit xanthine oxidase, when is it used

A

Allopurinol, used in prophylaxis setting at initiation of chemotherapy in high tumor burden malignancies

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15
Q

How is allopurinol doses, when is it given and continued

A

Using BSA: 300 mg/m2/d for a max of 800mg/day, give 1-2 days prior to induction chemotherapy, continue 3-7 days after chemotherapy until normalization of lab TLS

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16
Q

Drug interactions to allopurinol

A

meraptopurine, thiazide diuretics, and antibiotics

17
Q

What is rasburicase

A

recombinant urate oxidase, catalyzes oxidation of urate into allantoin (highly soluble with good urinary excretion)

18
Q

How does rasburicase effect uric acid, what is a key BBW

A

Uric acid levels decrease within 4 hours of administration, G6PD deficiency

19
Q

What is a key fact about rasburicase and its effect on uric acid measurement at room temperature, how can this be avoided

A

Enzymatically degrades uric acid in blood samples left at room temperature/ collect blood samples in pre-chilled tubes containing heparin, immediately immerse and maintain sample in an ice water bath, assay plamsa samples with 4 hours of collection

20
Q

What is dosing for rasburicase

A

0.2 mg/kg daily for 5 days OR 3 to 7.5 mg for one dose

21
Q

T/F: When TLS has been identified hydration with normal saline at 125 ml/hr should be started ASAP before chemotherapy

A

True

22
Q

What are the two go to options for treating hypercalcermia

A

Normal saline and calcitonin (antagonist of the parathyroid hormone)

23
Q

Which class of drugs that prevent breakdown of bine are used in hypercalcemia of malignancy (HOM)

A

IV Bisphosphaonates: Pamidronate and Zoledronic acid

24
Q

What is a mild case HOM, Moderate, severe

A

10.5-12, 12-14, Greater than 14

25
Q

T/F: If a patient has HOM what do they all recieve

A

Fluids for 6 hours then rechecked calcium

26
Q

What dose of zoledronic acid should be given for HOM

A

Zoldronic acid 4mg IV once

27
Q

Which drug is used as a last resort, why

A

Calcitonin, very expensive

28
Q

Which cancers are most common to metastasize to bone

A

Breast, Lung, Thyroid, Kidney, Prostate, multiple myeloma and lymphoma

29
Q

How are bone metastasize characterized

A

Osteolytic or osteoblastic

30
Q

What medications are osteoclast inhibitors

A

bisphonates and denosumab

31
Q

What is the dosing of pamidrone

A

60-90 mg IVPB administered over two hours

32
Q

What is the dosing for zolendronic acid

A

3-4 mg IVPB administrered over 15 minutes

33
Q

What is the MOA of denosumab, how is it dosed for treating of bone metastases, HOM

A

120 mg SC every 4 weeks (supplement)/ 120 mg SC every 4 weeks during the first month, give an addition 120 mg on days 8 and 15

34
Q

What are notable adverse reaction of denosumab

A

Osteonecrosis of the jaw, hypocalcemia. PTH levels increase when the patient has severe renal impairment (CrCl less than 30 or is on dialysis)

35
Q

What are the bone-targeted radiopharmaceutical therapies

A

Radium -223, Samarium 153 lexidronam (153 Sm), Strontium- 89 (89Sr)

36
Q

What is the MOA of Radium 223, what type of cancer is it used in

A

Mimics calcium to form complexes with bone mineral in areas with increased bone runover, alpha emission casued DS DNA breaks resulting in antitumor effect

37
Q

What are the warning of using Radium 223

A

Myelosuppression, dehydration, secondary malignancies

Phar 509 (22 decks)

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