supportive care: mucositis, hypercalcemia of malignancy, extravastion Flashcards
risk factors for mucositis
patient factors: smoking, baseline oral hygiene, younger age, female sex, pretreatment nutritional status
disease factors: head/neck cancer, treatment plan (chemo vs radiation), duration of treatment, dose of therapy, frequency of therapy
OLD chemo that promotes mucositis
antimetabolites: 5FU, MTX
anthracyclines: doxorubicin
platins: cisplatin, carboplatin
taxanes: docetaxel, paclitaxel
alkylating agents: cyclophosphamide
irinotecan
NEW chemo that promotes mucositis
mTOR inhibitors: everolimus
EGFR inhibitors: cetuximab
TKIs: afatinib
multi kinase inhibitors: sunitinib
CTLA-4: ipilimumab
how to prevent mucositis
prophylactic oral care
professional dental assessment if high risk
cryotherapy
mucoadhesive hydrogel rinses (MuGard)
supersaturated calcium phosphate rinses (BioSal)
AVOID PRODUCTS WITH ALCOHOL
Algorithm for treating mucositis with increasing symptom burden
bland rinses (NS, baking soda)
2% lidocaine swish and spit
diet modification
2% morphine swish and spit
systemic opioids
targeted agents that can be used for mucositis
dexamethasone mouthwash for everolimus
systemic steroids for refractory mTOR inhibitor mucositis
define irritant
ability to cause transient burning, pain, redness
define vesicant-like
usually categorized as irritant but has potential to cause localized blistering and necrosis
define vesicant
capable of causing edema, pain, erythema, tissue ischemia, blister/vesicle formation
signs and symptoms of extravasation injury
symptoms: tingling, burning, discomfort, pain
signs: swelling, redness/blanching, absence of blood return, resistance during IV bolus admin
treatment steps for extravasation
stop and disconnect infusion, leave needle in place
identify extravasated drug
attempt to gently aspirate as much extravasated drug as possible; avoid manual pressure over area as needle is removed
draw an outline around injury area
notify prescriber and start treatment specific measures ASAP
elevate affected limb and administer analgesia if needed
what are the 2 specific methods for extravasation
localize and neutralize
disperse and dilute
describe what to do for localize and neutralize
cold compress (Vasoconstriction)
antidote: dexrazoxane, DMSO, sodium thiosulfate
describe what to do for disperse and dilute
warm compress (vasodilation)
diluting agent: hyaluronidase
patient specific risk factors for extravasation
circulatory issues (PVD, Raynaud’s, fragile vein)
obesity
multiple venipunctures
impaired communication (dementia, aphasia)
iatrogenic risk factors for extravasation
inexperience
multiple cannulation attempts
unsuitable access site
infusion pump use
prolonged infusion
contributing medications to hypercalcemia of malignancy
calcium supplements, TPN
HCTZ/chlorthalidone
lithium
vitamin D
sedatives/hypnotics
opioids
contributing disease states to hypercalcemia of malignancy
renal impairment
what is the first line treatment for hypercalcemia of malignancy
aggressive hydration to dilute serum calcium and increase its excretion.
0.9% sodium chloride, plasmalyte, or LR
1 L bolus followed by 150-200 mL/hr infusion
when may antiresorptive therapies such as bisphosphonates or RANKL inhibitor be used for hypercalcemia of malignancy
for moderate or severe HCM
when may calcitonin be used for hypercalcemia of malignancy
severe HCM
onset/duration of bisphosphonates
onset 2-3 days
duration 1-4 weeks
can repeat dose in 7 days if poor response
which bisphosphonates are used for HCM
pamidronate, zoledronic acid (preferred bc better response)
monitoring for bisphosphonates
SCr (can cause ATN)
Ca level (May need to start Ca and Vit D for hypocalcemia)
