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PY3 > Supportive Care > Flashcards

Supportive Care Flashcards

1
Q

What are 4 risk factors of TLS? (Left side)?

A
  1. Bulky chemosensitive disease
  2. Blood cancer
  3. Elevated WBC
  4. High serum urate level
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2
Q

What are risk factors of TLS? (Right side)

A
  1. Elevated LDH
  2. Volume depletion
  3. Preexisting renal insufficiency
  4. Concentrated acidic urine pH
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3
Q

What does cell lysis result in?

A
  1. Hyperkalemia
  2. Hyperuricemia
  3. Hyperphosphatemia
  4. Hypocalcemia
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4
Q

What is the single most important intervention for TLS?

A

Hydration

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5
Q

What is the goal hydration for TLS?

A

2-3 L

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6
Q

When can you add loop diuretics for TLS?

A

After volume has been replaced

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7
Q

What are 2 hyperuricemic agents that are used in TLS?

A
  1. Allopurinol
  2. Rasburicase
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8
Q

What is allopurinol only useful for?

A

Prevention of TLS

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9
Q

What does rasburicase break down?

A

Uric acid

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10
Q

What 2 things can hyperkalemia cause?

A
  1. Arrhythmias
  2. Neuromuscular abnormalities
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11
Q

What drug can you use for mild hyperkalemia?

A

Sodium polystyrene sulfonate

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12
Q

What should you restrict for hyperphospatemia?

A

Dietary phosphate intake 800-1000 mg/d

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13
Q

Local allergic reactions without pain, usually accompanied by red blotches along the vein

A

Flare reaction

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14
Q

Agent capable of causing achiness, tightness, and phlebitis at the injection site or along with the vein

A

Irritant

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15
Q

Agent that is known to produce severe tissue damage and/or necrosis when infiltrated

A

Vesicant

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16
Q

Inadvertent administration of a solution or medication into the tissue surrounding and IV catheter

A

Infiltration

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17
Q

Inadvertent administration of a vesicant medication into the surrounding tissues

A

Extravasation

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18
Q

What does extravasation cause?

A

Severe and progressive tissue injury

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19
Q

What two drug classes have the highest vesicant potential?

A
  1. Anthracyclines
  2. Alkaloids
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20
Q

What is the treatment for vinca alkaloid extravasation?

A
  1. Apply a warm compress
  2. Hyaluronidase
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21
Q

What is the treatment for anthracycline extravasation?

A
  1. Apply a cool compress
  2. Dimethyl sulfoxide or Dexrazoxane
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22
Q

Dexrazoxane

A

TOTEC

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23
Q

What are the 2 MOAs of Dexarazoxane?

A
  1. Topoisomerase inhibitor
  2. Chelating agent
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24
Q

Where should you administer totec?

A

Into a large vein or extremity other than the one affected by the extravasation (opposite side of the body)

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25
Q

What is Zinecard used for?

A

Protects against anthracycline- induced toxicity

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26
Q

What does febrile neutropenia result in?

A

Myelosuppression

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27
Q

When is a patient considered neutropenic?

A

ANC< 1000

28
Q

When is a patient considered absolutely neutropenic?

A

ANC< 100

29
Q

What does the level of concern for neutropenia depend on? 3

A
  1. Degree
  2. Speed
  3. Length
30
Q

Cancer patients have blunted ________ responses.

A

Inflammatory

31
Q

The most important sign of infection in a neutropenic patient is

A

FEVER

32
Q

For febrile neutropenia, a single oral temperature of _____ or multiple oral temperatures of _______ persisting over __ hour(s)

A

> 38.3 C; > 38 C; 1

33
Q

What drugs can hide the fever of febrile neutropenia?

A
  1. Tylenol
  2. NSAIDs
  3. Steroids
34
Q

What are the only safe meds for neutropenic pain?

A

Opioids

35
Q

When CSFs are given after chemotherapy, what 3 things do they consistently reduce?

A
  1. Incidence
  2. Magnitude
  3. Duration of neutropenia
36
Q

What are the 2 available products for CSFs?

A
  1. Filgrastim
  2. Pegfilgrastim
37
Q

Filgrastim

A

Neupogen

38
Q

Pegfilgrastim

A

NEULASTA

39
Q

When can you use CSFs to prevent febrile neutropenia?

A

When chemotherapy regimen is associates with > or = to 20% incidence of febrile neutropenia

40
Q

What can be used to treat febrile neutropenia?

A

Antibiotics

41
Q

When can CSFs be considered in treating febrile neutropenia?

A

In cases of sepsis or other life-threatening conditions

42
Q

When should CSFs not be given?

A

During chemotherapy or radiation

43
Q

What are 3 ADRS of CSFs?

A
  1. Bone pain
  2. Injection site reactions
  3. Fever
44
Q

Mucosal damage occurring in the oral cavity, pharyngeal and laryngeal regions

A

Mucositis

45
Q

What are 5 risk factors for mucositis?

A
  1. Chemotherapy regimens with alkylating agents or topiosimerase II inhibitors
  2. Radiation to head or neck
  3. Poor dentition/ bad dentures
  4. Tobacco use
  5. Alcohol use
46
Q

What are 5 consequences of mucositis?

A
  1. Decreased oral intake/ malnutrition
  2. Infection
  3. Nausea and or vomiting
  4. Pain
  5. Dose delays or dose reductions
47
Q

What is the recovery of mucositis closely tied to?

A

The recovery of neutropenia

48
Q

What 3 things can be used to prevent mucositis?

A
  1. Dental assessment prior to therapy
  2. Oral hygiene
  3. Oral cryotherapy 30 mins before, during, and after chemo
49
Q

What 3 ways can you treat mucositis?

A
  1. Magic swizzle
  2. Opioids
  3. TPN or Feeding tube
50
Q

Patients are considered at end of life when they have what electrolyte imbalance?

A

Hypercalcemia

51
Q

Patients die within how many days when they have hypercalcemia?

A

30

52
Q

What are the two main hallmark symptoms of hypercalcemia?

A
  1. Polyuria
  2. Polydipsia
53
Q

What is the clinical presentation of hypercalcemia?

A
  1. Lethargy, confusion, nausea, constipation, shortened QT interval
  2. Renal failure
  3. Possible coma
54
Q

What is the corrected calcium equation?

A

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

55
Q

What is first line treatment for hypercalcemia?

A

Hydration with normal saline +/- furosemide

56
Q

What are the first and second line medications for hypercalcemia?

A

First line: 1. IV bisphosphonates
2. RANKL Inhibitor
Second line: calcitonin

57
Q

What are the 2 bisphosphonates used for hypercalcemia?

A
  1. Zoledronic Acid
  2. Pamidronate
58
Q

What are 2 ADRS of the bisphosphonates?

A
  1. Nephrotoxicity
  2. Osteonecrosis of the jaw
59
Q

What is the moa of the bisphosphonates?

A

Stuns the osteoclasts

60
Q

What RANKL inhibitor is used for hypercalcemia?

A

Denosumab

61
Q

What is Denosumab role in therapy?

A

Used for hypercalcemia refractory to bisphosphonates

62
Q

What toxicity does Denosumab have?

A

Can cause hypocalcemia

63
Q

You should use Denosumab in patients with what?

A

Severe renal impairment

64
Q

Calcitonin lowers Ca concentration but the response is?

A

Transient

65
Q

Why is calcitonin limited to the first 48 hours?

A

Due to tachyphylaxis

66
Q

For hypercalcemia, do you want to return calcium to normal levels?

A

No, goal is to gain mental functioning

67
Q

If further therapy is desired for hypercalcemia, what should you do?

A

Aggressively treat the cancer and change the therapy

PY3 (24 decks)

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