Management of cancer patients + imaging LC

Question 1

Malignancy prediction of cutaneous and subcutaneous neoplasms in canines using B-mode ultrasonography, Doppler, and ARFI elastography

Answer 1

Malignancy was associated with non deformable tissue and shear wave velocity > 3.52m/s

verified association between Heterogeneous echotexture, invasiveness, hyperechoic spots, cavity areas with malignancy

Question 2

Effect of slice thickness on computed tomographic perfusion analysis of the pancreas in healthy dog

Answer 2

Results supported that a thin slice thickness of 2.4 mm can be used for assessment of pancreatic perfusion variables in healthy dogs

Question 3

Use of computed tomography and radiation therapy planning software to develop a novel formula for body surface area calculation in dogs

Answer 3

Contoured BSA differed from the current formula by −9% to +19%.

Nonlinear regression on untransformed data yielded BSA = 0.0134 × body weight [kg]∧0.4746 × length (cm)∧0.6393 as the best-fit model.

Question 4

Metastatic diagnosis of canine sternal lymph nodes using computed tomography characteristics

Answer 4

Size (StLN-to-second sternebraratio [ratio-size]) and precontrast attenuation achieved a specificity and positive predictive value of 100% of identifying metastasis to sternal LN

Question 5

Staging canine patients with appendicular osteosarcoma utilizing fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography compared to whole body computed tomography

Answer 5

Comparing F-FDG PET/CT to whole body CT 13 osseous lesions concerning for mets were identified on PET/CT that would have been missed and 4 comordid neoplastic conditions
F-FDG PET/CT is more efficacious than whole body CT for staging

Question 6

what is the anitdote to mustargen extravasation

Answer 6

sodium thiosulfate

vesicant

Question 7

Pilot study to evaluate the efficacy of lymphotropic nanoparticle enhanced MRI for diagnosis of metastatic disease in canine head and neck tumours

Answer 7

LNMRI has the potential to be a sensitive and specific method of diagnosing lymph node metastasis

LNMRI utilizes ultra-small superparamagnetic iron oxide nanoparticles (USPIOs) to help in the detection of metastatic disease in lymph nodes. USPIOs are phagocytized and localized to normal lymph nodes where they assist in evaluation for regions of effacement by cancerous cells.

Question 8

Loperamide (Imodium)
MOA and tox

Answer 8

acts on opioid receptors in the gastrointestinal tract, slowing intestinal motility and reducing fluid secretion

operamide can cause central nervous system depression, manifested by sedation, ataxia, and respiratory depression, especially at high doses.

Cats are more sensitive to loperamide toxicity, and even small doses can lead to severe symptoms such as bradycardia, hypothermia, and respiratory depression.
Overdose can be life-threatening and requires immediate veterinary attention

Question 9

Kaolin-Pectin - mech /tox

Answer 9

Kaolin absorbs water and toxins in the gastrointestinal tract

safe

Question 10

Metronidazole (Flagyl)- mech/tox

Answer 10

Side effects can include gastrointestinal upset, nausea, vomiting, and in rare cases, neurotoxicity (e.g., ataxia, seizures) at high doses or with prolonged use.
Metronidazole should be used cautiously in animals with liver disease.

mech - disrupts protein and dna synthesis Bacteroides spp.
Clostridium spp.
Fusobacterium spp.
Peptostreptococcus spp.

Question 11

canalevia- Crofelemer

Answer 11

normalizes the hypersecretion of both the cyclic adenosine monophosphate (cAMP)-stimulated cystic fibrosis transmembrane conductance regulator (CFTR) chloride (Cl ) channel and the calcium-activated Cl channel (CaCC) at the luminal membrane of intestinal enterocytes. Disregulation of the CFTR and CaCC channels increases the osmotic gradient and causes excessive fluid influx into the lumen, resulting in secretory diarrhea.

Question 12

capromorelin mech

Answer 12

binds to ghrelin receptor stimulates the release of growth hormone (GH) from the pituitary gland and enhances appetite.

diarrhea, vomiting, polydipsia, hypersalivation, flatulence, nausea, abdominal discomfort, increased gut sounds, and lethargy.20 Elevated BUN and phosphorus have also been noted
may cause bradycardia transiently in cats

Question 13

cerenia mech/tox

Answer 13

neurokinin-1 (NK-1) receptor antagonist that acts in the emetic center within the CNS by inhibiting the binding of substance P, which is the key neurotransmitter involved in vomiting.

can cause prolongation of the QT interval because of cardiac potassium channel blockade

caution in hepatic failure - met in liver

Question 14

ondansetron mech/tox

Answer 14

5-HT3 receptor antagonist. 5-HT3 receptors are found peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone (CRTZ)

GI effects (eg, constipation, diarrhea), sedation, extrapyramidal clinical signs (eg, head shaking), increased liver enzymes, arrhythmias, and hypotension can be possible

humans get headaches

Question 15

mirtaz mech/tox

Answer 15

potent inhibitor of the 5-HT2, 5-HT3, and histamine (H1) receptors. Antagonism at 5-HT3 receptors accounts for the antinausea and antiemetic effects of the drug, and its action at H1 receptors produces prominent sedative effects. It is a moderate peripheral α1-adrenergic antagonist, a property that may explain the occasional orthostatic hypotension
antidepressant activity of mirtazapine appears to be mediated by antagonism at central presynaptic alpha-2

were vocalization (56%), agitation (31%), vomiting (26.2%), abnormal gait/ataxia (16.7%), restlessness (14.3%), tremors/trembling (14.3%), hypersalivation (13%), tachypnea (11.9%), tachycardia (10.7%), and lethargy

Question 16

metoclopramide mech/tox

Answer 16

antagonizes dopamine D2 receptors, is a weak inhibitor of serotonin 5-HT3 receptors, and is an agonist of serotonin 5-HT4 receptors. These actions help explain its sedative, central antiemetic, extrapyramidal, and prolactin secretion stimulation effects.

dopamine antagonist. Metoclopramide sensitizes upper GI smooth muscle to the effects of acetylcholine, stimulating motility of the upper GI tract without stimulating gastric, pancreatic, or biliary secretions.

changes in mentation and behavior (eg, motor restlessness, involuntary spasms, aggression, vocalization, hyperactivity, drowsiness, depression). Metoclopramide can increase detrusor muscle contractility and reduce bladder capacity. Adverse effects may be more likely to occur in dogs with renal or hepatic insufficiency

cats - frenzy

Question 17

cisapride mech and tox

Answer 17

Cisapride is a 5-HT4-receptor agonist that enhances the release of acetylcholine at the myenteric plexus without stimulating nicotinic or muscarinic receptors or inhibiting acetylcholinesterase activity.17,18 Cisapride is also a 5-HT1- and 5-HT3-receptor antagonist of the enteric cholinergic neurons; it is a direct 5-HT2-alpha-receptor agonist on colonic smooth muscle

safe in small animal species at recommended dosages. Occasionally, vomiting, diarrhea, and abdominal discomfort may be noted. may prolong QT

Question 18

gabapentin

Answer 18

bind to and inactivate presynaptic alpha2delta subunits of the voltage-gated calcium channels. By decreasing calcium influx, the release of excitatory neurotransmitters (eg, substance P, glutamate, norepinephrine) is inhibited. Although gabapentin is structurally related to gamma-aminobutyric acid type A (GABA), it is not a GABA agonist

Gabapentin was associated with an increased rate of pancreatic adenocarcinoma in male rats

Sedation and ataxia

Question 19

trazodone - mech tox

Answer 19

Trazodone is classified as a 5-HT2A and 5-HT2C antagonist/reuptake inhibitor (SARI) that primarily potentiates serotonin activity in the CNS.

GI disturbances (eg, nausea, vomiting, diarrhea, or colitis), ataxia, and sedation. Tachycardia, increased anxiety, behavior disinhibition, and aggression have also been reported.

Trazodone appears to exert qualitatively different and less pronounced cardiac conduction effects in dogs than do tricyclic antidepressants. In dogs, hepatotoxicity and transient priapism have been reported.

Question 20

feline pain scale

Answer 20

Question 21

canine pain scale

Answer 21

Question 22

equine pain scale

Answer 22

Question 23

qol scale (these are the principles of palliative and hospice care)

Answer 23

Question 24

Antibiotic prophylaxis in veterinary cancer chemotherapy: A review and recommendations

Answer 24

• risk of resistance
• w.o abx extra cost to vet owners for febrile neut hospitalization - most dont have insurance
• disruption of the microbiome –may reduce the efficacy of chemotherapy treatment
• prevent infection but induce microbial dysbiosis leading to potential pulmonary complications, reduced responses to chemotherapy, inflammatory colitis, C. difficile and resistant infection

Specific veterinary studies assessing
resistance in chemotherapy patients are not available. However, prior antimicrobial use has been identified as a risk factor for resistance in Staphylococcus pseudointermedius ear and skin isolates in dogs

Question 25

does antibiotic usage make chemotherapy less effective

Answer 25

disruption of the microbiome –may reduce the efficacy of chemotherapy treatment

A study in mouse models of colon carcinoma and melanoma has revealed that tumour necrosis and immune responses after treatment with platinum chemotherapy were reduced in mice treated with antimicrobials prior to therapy

commensal microbiome (particularly in the small intestine) is essential for an optimal response to chemotherapy. This is likely to be because of the effects such as bacterial translocation and activation of helper T cells, induction of reactive oxygen species and modulation of cell functions in the tumour microenvironment

Question 26

when to start abx after febrile neutropenia noted

Answer 26

recommend in humans starting antimicrobial therapy within 1 hour of documenting pyrexia and neutropenia

Question 27

febirle neutropenia occur when after chemo

Answer 27

typically at the expected nadir but

One study found that 40% of febrile neutropenic episodes occurred outside the expected period of neutropenia (the period of prophylaxis in this study) suggesting that timing based on the anticipated neutropenia may not be optimal

Question 28

SE seen in chemo overdoses

Answer 28

lethargy, anemia, neutropenia, thrombocytopenia, anorexia, diarrhea, nausea, vomiting, ileus, cystitis, mental depression requiring O2, death

all signs lasted an average of 1 week 4-10 days

Question 29

is filgastrim beneficial in chemo OD

Answer 29

unclear if it works in canines

in an od study - 4/5 dogs who received prophylactic filgastrim still developed neutropenia - gr 3-4

Question 30

What drugs have been found to overdose small dogs with BSA?

Answer 30

Doxorubicin, cisplatin, carboplatin, melphalan

Question 31

Plasmapheresis may reverse all side-effects of what chemotherapy overdose

Answer 31

cisplatin and vincristine - maybe all platinums - human lit

both highly nephrotoxic (compromising endogenous clearance) and are highly protein bound with long half-lives, lending themselves to removal via TPE

Question 32

tumor volume calculation according to human literature

Answer 32

v = l x w^2 x 0.5 ( bc height is hard to measure)

OR

v = 4/3 x 𝜋 x L/2 x w/2 x h/2 ( assumes elliptical shape)

since height is hard to measure use
h = 2/3 (L)

Question 33

tumor volume according to stelfonta

Answer 33

0.5 x [length (cm) x width (cm) x height (cm)]

volume cannot not exceed 10cm3

Question 34

how does stelfonta work ?

Answer 34

The active ingredient for tigilanol tiglate injection is a phorbol ester that activates alpha, beta I, beta II, and gamma isoforms of protein kinase C.

oncolysis, stimulation of acute inflammatory response and increased permeability of tumor vasculature

Question 35

STELFONTA dose volume calculation

Answer 35

0.5 x calculated tumor volume = mL

total dose is not more than 5mL or
0.25mL/kg

Minimum dose 0.1mL.