Supportive Care Flashcards
What are 4 risk factors of TLS? (Left side)?
- Bulky chemosensitive disease
- Blood cancer
- Elevated WBC
- High serum urate level
What are risk factors of TLS? (Right side)
- Elevated LDH
- Volume depletion
- Preexisting renal insufficiency
- Concentrated acidic urine pH
What does cell lysis result in?
- Hyperkalemia
- Hyperuricemia
- Hyperphosphatemia
- Hypocalcemia
What is the single most important intervention for TLS?
Hydration
What is the goal hydration for TLS?
2-3 L
When can you add loop diuretics for TLS?
After volume has been replaced
What are 2 hyperuricemic agents that are used in TLS?
- Allopurinol
- Rasburicase
What is allopurinol only useful for?
Prevention of TLS
What does rasburicase break down?
Uric acid
What 2 things can hyperkalemia cause?
- Arrhythmias
- Neuromuscular abnormalities
What drug can you use for mild hyperkalemia?
Sodium polystyrene sulfonate
What should you restrict for hyperphospatemia?
Dietary phosphate intake 800-1000 mg/d
Local allergic reactions without pain, usually accompanied by red blotches along the vein
Flare reaction
Agent capable of causing achiness, tightness, and phlebitis at the injection site or along with the vein
Irritant
Agent that is known to produce severe tissue damage and/or necrosis when infiltrated
Vesicant
Inadvertent administration of a solution or medication into the tissue surrounding and IV catheter
Infiltration
Inadvertent administration of a vesicant medication into the surrounding tissues
Extravasation
What does extravasation cause?
Severe and progressive tissue injury
What two drug classes have the highest vesicant potential?
- Anthracyclines
- Alkaloids
What is the treatment for vinca alkaloid extravasation?
- Apply a warm compress
- Hyaluronidase
What is the treatment for anthracycline extravasation?
- Apply a cool compress
- Dimethyl sulfoxide or Dexrazoxane
Dexrazoxane
TOTEC
What are the 2 MOAs of Dexarazoxane?
- Topoisomerase inhibitor
- Chelating agent
Where should you administer totec?
Into a large vein or extremity other than the one affected by the extravasation (opposite side of the body)
What is Zinecard used for?
Protects against anthracycline- induced toxicity
What does febrile neutropenia result in?
Myelosuppression
When is a patient considered neutropenic?
ANC< 1000
When is a patient considered absolutely neutropenic?
ANC< 100
What does the level of concern for neutropenia depend on? 3
- Degree
- Speed
- Length
Cancer patients have blunted ________ responses.
Inflammatory
The most important sign of infection in a neutropenic patient is
FEVER
For febrile neutropenia, a single oral temperature of _____ or multiple oral temperatures of _______ persisting over __ hour(s)
> 38.3 C; > 38 C; 1
What drugs can hide the fever of febrile neutropenia?
- Tylenol
- NSAIDs
- Steroids
What are the only safe meds for neutropenic pain?
Opioids
When CSFs are given after chemotherapy, what 3 things do they consistently reduce?
- Incidence
- Magnitude
- Duration of neutropenia
What are the 2 available products for CSFs?
- Filgrastim
- Pegfilgrastim
Filgrastim
Neupogen
Pegfilgrastim
NEULASTA
When can you use CSFs to prevent febrile neutropenia?
When chemotherapy regimen is associates with > or = to 20% incidence of febrile neutropenia
What can be used to treat febrile neutropenia?
Antibiotics
When can CSFs be considered in treating febrile neutropenia?
In cases of sepsis or other life-threatening conditions
When should CSFs not be given?
During chemotherapy or radiation
What are 3 ADRS of CSFs?
- Bone pain
- Injection site reactions
- Fever
Mucosal damage occurring in the oral cavity, pharyngeal and laryngeal regions
Mucositis
What are 5 risk factors for mucositis?
- Chemotherapy regimens with alkylating agents or topiosimerase II inhibitors
- Radiation to head or neck
- Poor dentition/ bad dentures
- Tobacco use
- Alcohol use
What are 5 consequences of mucositis?
- Decreased oral intake/ malnutrition
- Infection
- Nausea and or vomiting
- Pain
- Dose delays or dose reductions
What is the recovery of mucositis closely tied to?
The recovery of neutropenia
What 3 things can be used to prevent mucositis?
- Dental assessment prior to therapy
- Oral hygiene
- Oral cryotherapy 30 mins before, during, and after chemo
What 3 ways can you treat mucositis?
- Magic swizzle
- Opioids
- TPN or Feeding tube
Patients are considered at end of life when they have what electrolyte imbalance?
Hypercalcemia
Patients die within how many days when they have hypercalcemia?
30
What are the two main hallmark symptoms of hypercalcemia?
- Polyuria
- Polydipsia
What is the clinical presentation of hypercalcemia?
- Lethargy, confusion, nausea, constipation, shortened QT interval
- Renal failure
- Possible coma
What is the corrected calcium equation?
Measured calcium + (0.8 x (4 - albumin level))
What is first line treatment for hypercalcemia?
Hydration with normal saline +/- furosemide
What are the first and second line medications for hypercalcemia?
First line: 1. IV bisphosphonates
2. RANKL Inhibitor
Second line: calcitonin
What are the 2 bisphosphonates used for hypercalcemia?
- Zoledronic Acid
- Pamidronate
What are 2 ADRS of the bisphosphonates?
- Nephrotoxicity
- Osteonecrosis of the jaw
What is the moa of the bisphosphonates?
Stuns the osteoclasts
What RANKL inhibitor is used for hypercalcemia?
Denosumab
What is Denosumab role in therapy?
Used for hypercalcemia refractory to bisphosphonates
What toxicity does Denosumab have?
Can cause hypocalcemia
You should use Denosumab in patients with what?
Severe renal impairment
Calcitonin lowers Ca concentration but the response is?
Transient
Why is calcitonin limited to the first 48 hours?
Due to tachyphylaxis
For hypercalcemia, do you want to return calcium to normal levels?
No, goal is to gain mental functioning
If further therapy is desired for hypercalcemia, what should you do?
Aggressively treat the cancer and change the therapy
