Complications Of Malignancies Flashcards
(20 cards)
Symptoms appear during first exposure to a “new” drug and may be difficult to distinguish from anaphylaxis
CYTOKINE RELEASE SYNDROME
potentially life-threatening systemic inflammatory reaction observed after infusion of agents targeting different immune effectors
CYTOKINE RELEASE SYNDROME
Management of Cytokine Release syndrome if with fever and mild organ toxicity and NO Hypotension:
Grade I
Supportive: Acetaminophen for fever, IVF
If neutropenic: empiric broad spectrum antibiotics and filgrastim
Management of Cytokine Release Syndrome if with hypotension, responsive to fluids/ vasopressors
Grade 2
Initial IV fluid bolus with normal saline 500–1000 mL
• Administer a second IV fluid bolus if systolic blood pressure remains <90 mm Hg
• For hypotension refractory to two IV fluid boluses, administer anti–IL-6 therapy tocilizumab 8 milligrams/kg IV or
siltuximab 11 milligrams/kg IV
• If hypotension persists after two fluid boluses and anti–IL-6 therapy, start vasopressors, transfer to intensive care unit,
obtain echocardiogram, and initiate hemodynamic monitoring
Antiemetics used for chemotherapy-induced vomiting
include
neurokinin-1 receptor antagonists (eg. PITANT)
serotonin receptor antagonists (eg. Ondansetron)
corticosteroids (eg. Dexamethasone)
For refractory nausea and vomiting that is chemo induced, we use:
benzodiazepines (eg. Midazolam)
dopamine receptor antagonists (eg. METOCLOPRAMIDE)
anti-psychotic (eg. Olanzapine)
rouleaux formation (red cells stacked like coins) on a peripheral blood smear
Hyperviscosity Syndrome
True or False
Laboratory measurement of plasma or serum viscosity will not identify hyperviscosity from polycythemia or leukemia
True
Management of Hyperviscosity Syndrome
> intravascular volume repletion
early involvement of a hematologist
emergency plasmapheresis
leukapheresis
If with coma:
2-unit (1000-mL) phlebotomy with concomitant volume
replacement using 2 to 3 L of normal saline.
Transfusion of red blood cells should be done with caution because such treatment may increase
blood viscosity. Long-term management is appropriate chemotherapy.
Define Neutropenia
ANC <1000
Severe <500
Profound <100
Laboratory abnormalities in Tumor lysis syndrome
HYPO Calcemia
3 HYPER: KUP
Hyper Kalemia
Hyper Uricemia
Hyper Phosphatemia
Management of Tumor Lysis Syndrome
Agressive IVF
Prophylactic Allopurinol (Hyperuricemia)
Avoid Calcium administration (may cause metastatic precipitation of calcium phosphate)
HEMODIALYSIS (corrects biochemical abnormalities)
most commonly associated with bronchogenic cancer
also occurs from chemotherapy, opioids, carbamazepine, and SSRI
SIADH
cancer patients with normovolemic hyponatremia
SIADH
Management of SIADH
Water restriction
Na: >125 mEq/L (>125 mmol/L)
water restriction of 500 mL/d and close follow-up
More severe hyponatremia:
Na: 110 and 125 mEq/L with mild to moderate
symptoms
Furosemide 0.5 to 1.0 milligram/kg PO with concomitant IV normal saline to maintain euvolemia and effect a net
free water clearance
For severe hyponatremia:
Na <110 mEq/L, with coma or repetitive or sustained seizures—infuse 3% hypertonic
saline (510 mEq/L) 100 mL over 10 to 15 minutes
most common tumors associated with malignant SVC syndrome
lung cancer (in 70%)
2nd most common assoc with SVC
lymphoma (20%)
Management SVC Syndrome
head elevation to decrease venous pressure in the upper body and supplemental oxygen
Corticosteroids (lymphoma) and loop diuretics
Radiation therapy (effective in 75% patients)
Most common malignancies associated with Hypercalcemia
Breast CA
Lung CA
Multiple Myeloma
Most common location of pathologic fractures from Malignancy
Axial skeleton (+calvarium)
And
PROXIMAL aspect of limbs
