PHRM 864: Therapeutics IV > Bone & Oncologic Emergency > Flashcards

Bone & Oncologic Emergency Flashcards

(54 cards)

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1
Q

For Hypercalcemia of Malignancy, what are some of the most common tumor types that can cause it?

A
  • Lung, Breast, Hematologic, Prostate
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2
Q

What is the Pathophysiology of HCM?

A
  • Increased Parathroid hormone
  • Increased resorption - Bone Breakdown
  • Decreased Elimination - Kidney Failure
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3
Q

What are some of the the reasons for HCM?

A
  • Humoral: Boney metastase that breakdown the bones –> caused by that parathyroid hormone stimulating osteoclast
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4
Q

What is the way that we calculate Corrected Calcium?

A
  • Serum Ca + 0.8 (4 - Serum Albumin)
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5
Q

What are some of the stages that could occur in HCM?

A
  • MILD: <12mg/dL
  • MODERATE: 12-14mg/dL
  • SEVERE: >14mg/dL
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6
Q

What is important to know about Mild HCM [<12mg/dL]?

A
  • HYDRATE!! [stop Ca supplements]
  • Bisphosphonates for Moderate symptoms [Zoledronic Acid or Panmidronate]
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7
Q

What are some of the signs and symptoms for Mild HCM?

A
  • Constipation, Fatigue [dont know you have it]
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8
Q

What is important to know about Moderate HCM [12-14mg/dL]?

A
  • HYDRATION!! [should lower Ca levels in 24-48 hours –> faster than bisphosphonate]
  • DONT give loop diuretics UNLESS overloaded
  • Bisphophonates [Zoledronic Acid IV over 15 mins; x7d]
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9
Q

What are some of the signs and symptoms for Moderate HCM?

A
  • N/V, Lethargy, Confusion, Weakness
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10
Q

What is important to know about Severe HCM [>14mg/dL]?

A
  • HYDRATION!!!!!!!!!
  • Bisphosphonates
  • Calcitonin [only after Hydration and Bisphosphonates]
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11
Q

What is important to know for Calcitonin in Severe HCM?

A
  • Tachyphylaxis after 48 hours
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12
Q

What are some of the signs and symptoms for Severe HCM?

A
  • Seizures, Coma, Heart Block, Arrhythmias, Asystole
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13
Q

When having refractory HCM, what is the specific treatment that should be used?

A
  • RANK-L Inhibitor: Stops the osteoclasts from breaking down bones [Denosumab]
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14
Q

When experiencing Chronic HCM, what are some of the treatments to use?

A
  • Zolendronic Acid IV over 15 minutes monthly
  • Pamidronate IV over 2 hours monthly
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15
Q

What is do the IV bisphosphonates due in HCM?

A
  • Inhibits osteoclast activity by apoptosis and stops differentiation
  • Decreases bone resorption
  • Concentrates at bone remodeling
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16
Q

What is the epidemiology of Bone Metastases in SREs?

A
  • Cancers that affect the bone [Breast, PROSTATE, Myeloma, Lung, Kidney]
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17
Q

How do you know if you have SREs?

A
  • Bony pains [pinpointed]
  • Radionucleotide bone scan
  • CT, MRI, PET scans
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18
Q

What are some of the risk factors for fractures in women with SRE?

A
  • BREAST CANCER
  • Aromatase Inhibitors, Age > 65, Smoking
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19
Q

What are some of the risk factos for fractures in men with SRE?

A
  • PROSTATE CANCER
  • Androgen Deprivation Therapy, Smoking
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20
Q

What is the general treatment overview for Bone Metastases in SRE?

A
  • Palliation of symptoms
  • Radiation, Chemotherapy, IV Agents, Radioisotopes
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21
Q

What is important to know about Radiation Therapy in SRE?

A
  • Helps with pain relief within 1-2 weeks [do not use longer than 6 weeks]
  • Radioisotopes
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22
Q

What are some of the radioisotopes that are used with Radiation for SRE?

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A
  • 131-Iodine: Thyroid Cancer
  • Radium-223: PROSTATE CANCER
  • Strontium & Samarium: Breast and Prostate
23
Q

What is important to know about the Radioisotopes in Radiation for SRE?

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A
  • Expensive
  • Myelosuppression
24
Q

What are the IV agents that are used for SRE?

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A
  • Bisphosphonates
  • Pamidronate IV 2 hours month
  • Zolendronic Acid IV 15 minutes monthly or bimonthly
25
Do the IV Bisphosphonates need renal adjustment for SRE?
- NEEDS RENAL ADJUSTMENT DOSING [only for SRE not HCM]
26
How do we calculate CrCl?
- = (140-age) x IBW / 72 x Scr - x 0.85 if female
27
What is Denosumab?
- RANK L inhibitor
28
What are the other types of Denosumab used for SRE?
- More for refectory - BONE METS = Xgeva every 4w - Osteopenia = Prolia every 6w
29
What are some of the considerations for Denosumab for SRE?
- SubQ - NO renal adjustments - EXPENSIVE [~$2500]
30
What are some of the main side effects that can occur from the SRE or HCM treatments?
- Osteonecrosis of Jaw - Renal Dysfunction - Hypocalcemia
31
What drugs are more likely going to cause Osteonecrosis of the Jaw from SRE or HCM?
- Zolendronic Acid & Denosumab > Pamidronate - Monthly > yearly - IV > PO
32
What drugs are more likely to cause Renal Dysfunction in SRE or HCM>
- Zoledronic Acid > Pamidronate > Denosumab - Bisphosphonate NOT CrCl < 30
33
What is Tumor Lysis Syndrome within Oncologic Emergenices?
- Death of Malignant cells that release intracellular contents into he blood [life threatening]
34
What are some of the risk factors for TLS in Oncologic Emergenices?
- Based on the type of cancer [Solid tumor wont do it BUT hematologic cancers can] - Tumor specific - Patient Specific: age, renal impairment, uric acid?
35
When the tumor cells lysis, what are some of the things that can happen?
- Hyperkalemia [Increased K] - Hyperuricemia [Increased Uria] - Hyperphosphatemia [Increased P] - Hypocalcemia [Decreased Ca]
36
What is are some of the side effects based on pathophysiology for TLS in Oncologic Emergenices?
- Hyperkalemia = cardio issues - Hypocalcemia = caused by the hyperphosphatemia - ALL pass through the kideny SO kidney failure increases all them
37
What are some fo the prinicple of management for TLS in Oncologic Emergencies?
- Identify high risk patients - Monitoring Electrolytes - HYDRATION - Control the Hyperuricemia
38
What are the patients that are more high risk for TLS in Oncologic Emergencies?
- Those with Lymphoma or Leukemias
39
What are some of the Prophylaxis measures to take for TLS in Oncologic Emergenices?
- Montoring & Hydration - Low and Moderate: Allopurinol - High: Rasburicase
40
What is the way that Allopurinol can help within TLS?
- Uric Acid and Xathine can lead to AKI - Allopurinal STOPS FUTURE production of uric acid NOT breakdown current - Use before chemo
41
What is MOA for Rasburicase in High Risk TSL?
- Can stop breakdown CURRENT and FUTURE uric acid in 4 hours - Use in patients that cant use Allopuinol
42
What are some of the limitations for Rasburicase in High Ris TSL?
- G-6-P deficiency - CONTRAINDICATED in pregnant or breast-feeding - $$$$$$
43
Within TSL, what are some of the ways that we can manage electrolyte abnormalites?
- Hyperkalemia [K]: Calcium Gluconate, Dextrose, Insulin, Sodium Bicarb, loop diuretices - Hyperphophatemia [P]: Phospate Binder - Hypocalcemia [Ca]: DONT treat asymptomatic; Symptomatic = calcium gluconate
44
What is Malignant Spinal Cord Compression within Oncologic Emergenics?
- Compression of spinal cord that is caused by Breast, Lung PROSTATE cancers - THIS IS AN EMERGENCY!!!!
45
What are some of the Symptoms of MSCC?
- Pain: back pain is most common - Motor Deficit: weakness & gait - Sensory Deficit: numbness of toes or fingers - Autonomic Dysfuction: cant make it to the bathroom [RED FLAG]
46
If you suspect someone to have MSCC, what is important to do first?
- STERIODS [Dexamethasone] - MRI of the WHOLE spinal cord
47
What are some of the treatment options for MSCC?>
- STEROIDS IMMEDIATELY: Dexamethazone 10 mg - Surgery & Rads are the only treatments that has immediate relief
48
What is important to know about Radiation & Surgery in MSCC?
- Radiotherapy: stops further growth - Surgery: Laminectomy, Vertebroplasty, Kyphoplasy [concrete balloon]
49
What is Superior Vena Cava Syndrome in Ocologic Emergenies?
- The compressing of the SVC causes a decrease in drainage from the head, neck, and upper extremities - NOT really an oncologic emergency??
50
What are some of the signs and symptoms for SVC?
- Facial and Arm Edema, Cough, Stridor, Dysphagia
51
What is the way that we treat SVC syndrome ?
- Alleviated the symptoms & treat cause - Stents, anticoag? - Elevate the head [decreased edeme], Steroids [inflammation], Diuretics [decrease fluids]
52
What is a Malignant Pleural Effusion in Onologic Emergenceies?
- Fluid in the plural space by the lungs - Can be causes by Lung, Breast and Lymphoma
53
What are the symptoms PE and how do we diagnosis it?
- NO real symtpoms: SOB & Pain - Chest x-ray is 1st
54
How are we able to manage MPE?
- Thoracentesis: Needle that removes fluid from pleural area [drain 1-1.5L; could cause infections] - Cathator
PHRM 864: Therapeutics IV
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