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Oncology > Supportive Care > Flashcards

Supportive Care Flashcards

1
Q

What is tumor lysis syndrome?

A

result of massive breakdown of tumor cells; intracellular content is released faster than the body can eliminate them

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2
Q

When does TLS happen?

A

spontaneously OR result of treatment

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3
Q

What are risk factors for TLS?

A

Bulky, chemosensitive disease
Lymphoproliferative malignancy (blood cancer)
Elevated WBCs
High serum urate
Elevated LDH
Volume depletion
Renal insufficiency
Acidic urine pH

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4
Q

What electrolyte imbalances are the result of TLS?

A

Hyperkalemia
Hyperuricemia
Hyperphosphatemia
Hypocalcemia

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5
Q

What is the most important intervention for TLS?

A

Hydration; ~2-3 L/m2/day
Loop diuretics can be added after volume replacement

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6
Q

Which agent is given prior to chemo to prevent hyperuricemia?

A

Allopurinol

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7
Q

Which agent breaks down uric acid into a soluble form and can be used to treat hyperuricemia?

A

Rasburicase

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8
Q

What is the result of hyperkalemia?

A

arrhythmias
neuromuscular abnormalities

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9
Q

What is given for mild hyperkalemia (no arrhythmias)?

A

Sodium Polystyrene Sulfonate (KAYEXALATE)

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10
Q

What is given for severe hyperkalemia (EKG changes)?

A

Regular Insulin+ dextrose

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11
Q

What is a local allergic reaction (red blotches along vein) without pain?

A

flare reaction

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12
Q

What is an agent capable of causing tightness, achiness, and phlebitis (inflammation of vein)?

A

irritant

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13
Q

What is an agent that is known to produce severe tissue damage and/or necrosis when infiltrated?

A

vesicant

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14
Q

What is the administration of solution/ medication into tissue surrounding an IV?

A

infiltration

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15
Q

What is the administration of a vesicant into surrounding tissues?

A

extravasation

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16
Q

Why is extravasation a medical emergency?

A

blistering and sloughing off of tissue begins 1-2 weeks after injury; tissue necrosis follows

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17
Q

What agents have the highest vesicant potential?

A

Daunorubicin
Doxorubicin
Epirubicin
Idarubicin
Vinblastine
Vincristine
Vinorelbine

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18
Q

What is treatment of vinca alkaloid extravasion?

A

Apply warm compress around area QID for 48-72 hours;
Antidote: hyaluronidase injections x 1 day

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19
Q

What is treatment of anthracycline (rubucin) extravasation?

A

Apply cool compress around area QID for 48-72 hours;
Antidote: dimethyl sulfoxide topically QID x 14 days OR
IV Dexrazoxane

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20
Q

Where is IV Dexrazoxane administered?

A

large vein other than one affected by extravasation

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21
Q

Why does Dexrazoxane have 2 different brand names?

A

ZINECARD- anthracycline-induced cardiotoxicity
TOTECT- anthracycline extravasation

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22
Q

What is myelosuppression?

A

decreased production of cells made by bone marrow

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23
Q

What is the result of myelosuppression?

A

neutropenia (decreased WBC)
anemia (decreased RBC)
thrombocytopenia (decreased platelets)

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24
Q

What is considered neutropenic?

A

ANC < 1000

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25
Q

What is considered absolutely neutropenic?

A

ANC < 100

26
Q

What is a normal ANC (neutrophil count)?

A

ANC = 2000-5000

27
Q

What is considered febrile neutropenic?

A

neutropenic AND
oral temperature > 38.3C (101F) or multiple oral temperatures >38C (100.5F) over 1 hour

28
Q

What medications should NOT be used when febrile neutropenia is suspected/ present?

A

Tylenol
NSAIDs
Steroids

29
Q

What medications can be used for pain with febrile neutropenia?

A

opioids

30
Q

What medications can be given after chemo to reduce the incidence, magnitude, and length of neutropenia?

A

Colony Stimulating Factors (CSFs)

31
Q

When are CSFs used to prevent neutropenia?

A

chemo regimen associated with >/= 20% incidence of febrile neutropenia

32
Q

When should CSFs be started to prevent febrile neutropenia?

A

24-72 hours after chemo competed

33
Q

Granulocyte CSF

A

Filgrastim (NEUPOGEN)

34
Q

Pegylated CSF

A

Pegfilgrastim (NEULASTA)

35
Q

When would we treat for febrile neutropenia?

A

< 20% incidence of febrile neutropenia but patient gets it anyway; would prevet every time after indecent

36
Q

When should CSFs not be given?

A

During chemo/ radiation

37
Q

What are the side effects of CSFs?

A

Bone pain (means its working)
injection site reaction
fever

38
Q

What is mucositis?

A

ranges from mild inflammation and erythema to bleeding ulcerations in oral cavity

39
Q

What is the prevalence of mucositis?

A

75% of those receiving chemo
Nearly all patients receiving chemo + radiation of head and neck

40
Q

What are risk factors for mucositis?

A

Chemo containing alkylating agents or Topoisomerase II inhibitors;
Radiation to head/ neck;
Poor dentation;
Tobacco use;
Alcohol use

41
Q

What are the complications of mucositis?

A

Decreased oral intake–> malnutrition;
Infection;
N/V;
Pain;
Dose delay/ reduction–> negative tx outcome

42
Q

What is mucositis closely related to?

A

neutropenia

43
Q

When does mucositis usually occur?

A

5-7 days after start of chemo/ radiation

44
Q

How is mucositis prevented?

A

Dental assessment prior to tx;
Oral hygiene;
Ice (cryotherapy) for 30 mines before, during, and after chemo

45
Q

What are treatment options for mucositis?

A

Topical lidocaine, magic mouthwash
Opioids
Parenteral Controlled Analgesia (PCA)
TPN/ feeding tube

46
Q

What is an indication of poor prognosis (50% die within 30 days)?

A

hypercalcemia of malignancy

47
Q

What clinical presentations are common for hypercalcemia of malignancy?

A

polyuria and polydipsia (body trying to flush out calcium)

48
Q

What types of cancer are associated with local osteolytic hypercalcemia?

A

hormonal cancers like to goto bone and turn them into dust

49
Q

What type of hypercalcemia of malignancy is most common?

A

Humoral hypercalcemia

50
Q

Why do we need to correct calcium lab values?

A

calcium is usually bound to albumin in the blood; low albumin does not mean low calcium

51
Q

What is the corrected calcium equation?

A

Measured calcium +
[0.8 x (4 -albumin level)]

52
Q

How is hypercalcemia treated?

A

Hydration with normal saline +/- furosemide
1st line meds
2nd line meds

53
Q

What are the 1st line meds for hypercalcemia?

A

Bisphosphonates (Zoledronic Acid, Pamidronate)
RANKL inhibitor (Denosumab)

54
Q

What is the mechanism of Bisphosphonates?

A

“stun” osteoclasts to prevent bone degradation

55
Q

What rare but serious side effect is associated with bisphosphonates, usually with long-term use?

A

osteonecrosis of the jaw (ONJ)

56
Q

What is the mechanism of RANKL inhibitors?

A

destroys osteoclasts

57
Q

When are RANKL inhibitors typically used?

A

hypercalcemia refractory to bisphosphonates

58
Q

What side effect is related to the mechanism of RANKL inhibitors?

A

severe hypocalcemia

59
Q

What is the 2nd line tx of hypercalcemia, usually for emergency treatment?

A

Calcitonin

60
Q

How does calcitonin work to treat hypercalcemia?

A

drives calcium intracellularly

61
Q

What problems are seen with calcitonin?

A

transient (short) response duration and tachyphylaxis (less effective over time)

62
Q

What are the goals of hypercalcemia therapy?

A

restore mental functioning so patient can make tx decisions; NOT to restore normal calcium

Oncology (22 decks)

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