Oncologic Emergencies Flashcards by Nicole Gaudreau

What are metabolic/hormonal cancer related complications?

Tumor lysis syndrome
Hyperglycemia of malignancy
SIADH
Paraneoplastic syndrom

How well did you know this?

Not at all

Perfectly

What are structural cancer related complications?

Superior vena cava syndrome
Pleural or pericardial effusion
Spinal cord compression

How well did you know this?

Not at all

Perfectly

What are chemotherapy-related cancer related complications?

Extravasation

Diarrhea/Constipation

How well did you know this?

Not at all

Perfectly

What are hematologic cancer-related complications?

Febrile neutropenia
Hyperviscosity syndrome
Thromboembolic risk associated with cancer

How well did you know this?

Not at all

Perfectly

What is TLS?

Tumor lysis syndrome

Metabolic complications resulting from abrupt release of cellular components into the blood

How well did you know this?

Not at all

Perfectly

What may TLS result in?

Acute renal failure

How well did you know this?

Not at all

Perfectly

What are the typical electrolyte abnormalities of TLS?

Hyperphosphatemia
Hyperkalemia
Hypocalcemia

How well did you know this?

Not at all

Perfectly

What is the pathophysiology of TLS?

Release of nucleic acids –>
Hyperuricemia–>
Uric acid crystal ppt in renal tubules –> –>
Acute obstructive nephropathy

How well did you know this?

Not at all

Perfectly

What are the tumor related toxicities of TLS?

Type of malignancy - more common with acute hematologic malignancies
High tumor burden
Chemotherapy-sensitive disease

How well did you know this?

Not at all

Perfectly

What are the patient related risk factors of TLS?

Pre-existing renal dysfunction
Elevated uric acid, WBC, serum LDH
Dehydration

How well did you know this?

Not at all

Perfectly

What is the cairo-bishop classification?

2 or more lab changes up to 7 days after chemotherapy

How well did you know this?

Not at all

Perfectly

What is an elevated uric acid level per cairo-bishop classification?

8.0+

25%+ increase from baseline

How well did you know this?

Not at all

Perfectly

What is an elevated potassium level per cairo-bishop classification?

6.0+

25%+ increase from baseline

How well did you know this?

Not at all

Perfectly

What is an elevated phosphorous level per cairo-bishop classification?

6.5+ (children)
4.5+ (adults)
25% + increase from baseline

How well did you know this?

Not at all

Perfectly

What is an elevated calcium level per cairo-bishop classification?

Less than 7.0

25% decrease from baseline

How well did you know this?

Not at all

Perfectly

What are the clinical presentations of TLS?

Non-specific complaints**
Acute renal failure
Arrhythmias
Neuromuscular weakness
Tetany

How well did you know this?

Not at all

Perfectly

What is the treatment outline for TLS?

Aggressive emergency care
Fluids and hydration
Management of hyperuricemia
Management of electrolytes
Monitor and follow-up

How well did you know this?

Not at all

Perfectly

How do we manage hyperuricemia in TLS?

Allopurinol (to prevent remission)

Rasburicase (treatment)

How well did you know this?

Not at all

Perfectly

How is Allopurinol administered?

How well did you know this?

Not at all

Perfectly

How must allopurinol be adjusted?

Renal dysfunction

How well did you know this?

Not at all

Perfectly

Does allopurinol affect uric acid produced prior to initiation?

How well did you know this?

Not at all

Perfectly

What are the AEs of allopurinol?

N/V
Precipitate gout flare
Increased LFTs

How well did you know this?

Not at all

Perfectly

What is the indication for Rasburicase?

Patients with hyperuricemia secondary to leukemia, lymphoma or solid tumor malignancies; indicated for a single course of treatment

How well did you know this?

Not at all

Perfectly

How is rasburicase administered?

How well did you know this?

Not at all

Perfectly

What is the BBW of rasburicase?

Anaphylaxis Hemolysis Methemoglobinemia

What are monitoring issues with rasburicase?

Collect blood in prechilled heparinized tubes Immerse in ice water Analyze samples w/in 4 hours

What is the management of hyperkalemia?

Insulin and glucose Albuterol Diuretics/dialysis Bicarbonate

What is the treatment of hyperphosphatemia?

Phosphate binds IV fluids Dialysis

What is the treatment of hypocalcemia?

Treat phosphorous levels

How do we monitor pts with TLS?

``` Renal function I&Os SCr Electrolytes EKG ```

What range is severe hypercalcemia?

14+

What is the corrected calcium equation?

Observed Ca + 0.8 (4 - albumin)

What is the pathophysiology of hypercalcemia of malignancy?

Increased bone resorption | Enhanced renal tubular and intestinal reabsorption

What medications may cause hypercalcemia?

Calcium supplements HCTZ Lithium

What are the clinical presentations of hypercalcemia of malignancy?

``` "Stones, bones, ab groans, psychiatric moans" Renal GI Neurologic CV ```

What are the renal presentations of hypercalcemia of malignancy?

``` Kidney stones Polyuria Polydipsia Dehydration Decreased GFR ```

What are the GI presentations of hypercalcemia of malignancy?

Constipation N/V Anorexia

What are therapies for hypercalcemia of malignancy?

D/c exogenous sources of calcium Hydration (watch CV status) Diuresis (after establishing rehydration) Bisphosphonate therapy

What is a follow up therapy if bisphosphonates do not fix calcium after the second dose?

Calcitonin Denosumab (if refractory to zolendronic acid) Glucocorticoids (in steroid responsive diseases) Mithramycin (chemo) Gallium nitrate (chemo) Dialysis

What are the causes of superior vena caca syndrome?

SVC obstruction Malignancy - lung cancers most common Non-oncologic

What are the s/sx of vena cava syndrome?

``` Facial/neck swelling Upper extremity swelling Dyspnea Cough Dysphagia/stridor Syncope Sensation of fullness in head Distended neck/chest veins Facial, neck, arm edema Facial plethora Cyanosis ```

What are the classifications of vena cava syndrome?

0-5 0=asymptomatic 5=death

How is vena cava syndrome diagnosed?

Made with s/sx and imaging studies

How is vena cava syndrome managed?

Treat underlying cause (chemo/radiation) Endovascular revascularization Supportive measures (elevate head of the bed/O2) Corticosteroids/diuretics (controversial Anticoagulation for thrombosis-related obstruction

What cancers are the most common causes of pleural effusions?

Lung Breast Lymphoma

What cancers are the most common causes of pericardial effusions?

``` Lung Breast Leukemia/lymphoma GI Sarcomas Melanoma ```

What is the pathophysiology of pleural/pericardial effusions?

Impaired balance between normal fluid production and elimination

What is the clinical presentation of pleural and pericardial effusions?

Dyspnea Cough Chest pain

What is on the PE of pleural and pericardial effusions?

Decreased breath sounds Dullness to percussion Decreased fremitus Pericardial rub

What is the treatment for plerual/pericardial effusions?

``` Treat the underlying cause Diagnostic tap (may turn into therapeutic tap) Thoracentesis/chest tube drainage Pleurodesis/sclerotherapy Doxycycline/bleomycin/talc ```

What is pleurodesis?

Put talc into space where fluid was so that it won't fill back up and closes it like a glue

What are AEs of using doxycycline in pleural/pericardial effusion?

Pain | Fever

What are AEs of using bleomycin in pleural/pericardial effusion?

Pain Fever Alopecia Dyspnea

What are the AEs of talc in pleural/pericardial effusion?

Pain Hypotension Infection

What cancers commonly cause spinal cord compression (SCC)?

Prostate cancer Breast cancer Lung cancer RCC, NHL, MM, CRC, sarcoma

What is the clinical presentation of SCC?

Pain - mainly back

What are the motor findings of SCC?

Weakness Hyperreflexia below level of compression +Babinski sign Diminished LE deep tendon reflexes

What are sensory findings of SCC?

Paresthesias (ascending numbness most common)

What autonomic dysfunction does SCC cause?

Urinary retention

What are the therapy options for SCC?

Tailored to patient severity HD dexamethasone (LD + 4-24 mg q6h) Surgery and radiation Supportive care

What is extravasation?

Accidental leakage of chemotherapy from the vein into the surrounding tissue

What are irritants that cause extravasation?

``` Cisplatin Oxaliplatin Irotecan Topotecan Paclitaxel ```

What vesicants cause extravasation?

Anthracyclines Vinca Paclitaxel Mitomycin

What are patient related RFs for extravasation?

Age Unable to communicate Impaired circulation

What are procedure related RFs for extravasation?

Administration technique IV/port site Drug itself (cellular toxicity) Mobility of patient

What are preventative measures for extravasation?

Patient and staff education Check patency of lines, appropriate veins and equipment Avoid easily "dislodged" lines Flush line before and after administration Use thin cannulas with high gauges Monitor closely Recognition of patient sx

What is the management of extravasation?

``` Stop infusion - leave needle/cannula/catheter in place Slowly aspirate as much drug as possible Apply antidote (if applicable) Withdraw IV access Elevate area to minimize swelling Mark affected area and photograph Plastic surgery may be necessary ```

What is the localize and neutralize method?

Application of cold pack to affected area

How does localize and neutralize method work?

Cold causes vasoconstriction to localize the extravasation DMSO Dexrazoxane Sodium thiosulfate

What is the disperse and dilute method?

Application of warm compress to affected area

For which agents is disperse and dilute used?

Vincas | Oxaliplatin

How does disperse and dilute work?

Warm causes decreased local drug concentrations | Hyaluronidase - pharmacological dispersing agent sometimes used, but limited evidence

Oncologic Emergencies Flashcards

(72 cards)