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Flashcards in Endocrine/Cancer Deck (77)
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1

Common CA surgeries for men

Prostate (#1)
Lung (#2)
Colon/GI

2

Most common CA surgery for women

Breast

3

Common sites of metastases for resection

Brain, liver, spinal cord

4

Considerations for lung CA surgery

1) Potential for massive bleeding during surgery (make sure to type and cross and set up blood warmer)
2) Pulmonary insufficiency after lung tissue resection (will remain intubated after surgery, get a-line to check ABGs)
3) May have associated CAD

5

Considerations for bronchial and neck CA surgery

1) Look at imaging to determine airway management
2) Ask if they have dysphagia or trouble breathing (checking for airway obstruction)
3) We will lack close accessibility to the airway during the case d/t surgical location
4) Expect significant blood loss

6

Considerations for those on chemo/radiation

CBC
Check for peripheral neuropathies (chemo can cause these)

7

Affect of CA and treatment on the heme system

1) Anemia (d/t bone marrow suppression or GI ulceration/bleeding)
2) Neutropenia and thrombocytopenia

8

Recurrent venous thrombus can occur with ___ CA

pancreatic

9

Types of lung cancers and their effects on the body

1) Squamous (25-40% incidence)
- hypercalcemia
2) Adenocarcinoma (35-50%)
- hypercoagulability & osteoarthritis
3) Large cell (10%)
- gynecomastia
4) Small cell (15-24%)
- Ectopic corticotropin secretion
- Excess ADH secretion
- Eaton-Lambert Syndrome (similar disease process to MG--> will affect the type of NMB we use)

10

When may adrenal insufficiency occur?

Adrenal tumor
Corticosteroid therapy

11

What can happen if TPN is abruptly stopped?

Hypoglycemia

12

Effects of malignant involvement of the pericardium

1) Pericardial tamponade (often happens as a result of lung CA)
- Electrical alternans (alternation of QRS complex amplitude or axis between beats- the heart essentially wobbles in the fluid filled pericardium)
- Paroxysmal a-fib or a-flutter

13

Chemo can cause this effect on the heart

Drug induced cardiomyopathy
- LV function may be impaired for up to 3 years post therapy

14

Invasion of the mediastinum can cause

SVC obstruction
- causes venous engorgement above the waist
Dyspnea and airway obstruction

15

Chemo meds that are cardiac toxic

Doxorubicin and Daunorubicin
- Causes CHF in <3%
- Acute cardiomyopathy in 10% (benign, and symptoms resolve in 1-2 months)
- SEVERE cardiomyopathy in 2% (mortality rate of 60% in 3 weeks, and unresponsive to mechanical/drug therapy)
- These meds enhance the myocardial depression caused by anesthetics (acute LV failure can occur with GA up to 2 months post treatment)

16

Chemo meds that are pulm toxic

1) Methotrexate (8% toxicity)
- sudden pulmonary edema (non-cardiogenic)
- progressive inflammation with infiltrates and effusions

2) Bleomycin (dose-related toxicity-- rare if below 150mg/m2)
- Pulm endothelial damage (treat with corticosteroids) --> can result in type I and II cell necrosis and pulm fibrosis (no tx)
- Increased A-a gradient
- Hyperoxic pulmonary injury (Do not give 100% O2*****)--> try to keep sats over 90% with less than 30% FiO2

17

Effects of 5-fluorouracil

Immunosuppression
Leukopenia
Megaloblastic anemia

18

Chemo meds that are renal toxic

Cisplatin (dose dependent)
- Decreased GFR within 3-5 days
- ATN -> ARF -> hemodialysis

How to treat??
- Hydration and mannitol diuresis (may help to protect against the advancement of renal toxicity)

19

Chemo meds that cause encephalopathy

1) High-dose cyclophosphamide (acute delerium)
2) Methotrexate (reversible, but can cause dementia with prolonged use)

20

These meds can cause neuropathies

1) Vinca alkaloids
- peripheral neuropathies
- Autonomic neuropathy (usually reversible)

2) Cisplatin
- dose-dependent damage to the doral root gangia --> large fiber neuropathy

21

What is autonomic neuropathy?

ANS dysfunction d/t DM
- 20-40% of all diabetics have it
- Most affects the CV and GI systems

Causes:
- Ortho hypotension
- Resting tachycardia
- Impotence
- Peripheral neuropathy
- Loss of HR variability
- Gastroparesis
- Cardiac dysrrhythmia
- Altered breathing regulation
- Sudden death syndrome

22

These chemo meds can cause plasma cholinesterase inhibition

Alkylating agents (Cytoxan)
--it will prolong the effect of sux!!

23

Bleomycin/Busulfan/BCNU can cause

Interstitial pneumonitis and fibrosis (3-6%)
- appears as cough, dyspnea, and basilar rales

Treatment:
- Corticosteroids
- Avoid high FiO2
- Use colloids rather than crystalloids

24

Cardiac complications due to doxorubicin/daunorubicin may first appear as

an upper respiratory infection, but with rapidly progress to CHF. Evaluate ventricular function.

Severe cardiomyopathy can occur if 550mg/m2

25

If a CA patient has N/V, you should always treat them as if they have

a full stomach

26

These meds are commonly used to treat N/V in the CA population

Reglan
Zofran
Droperidol

27

Type of pain scale we should use with CA patients

VAS (visual analogue scale)

28

CA airway evaluation

Tracheal compression or deviation?
Dysphagia or difficulty breathing (airway obstruction)
Trach?
One-lung ventilation?

29

CA and IV access

Prior mastectomy?
Remember that if on chemo, they may have poor vasculature/access
- Allow adequate time to get enough access
- Pt will often know where their best access sites are

30

What are we most concerned about with DM?

Making sure they don't become hypoglycemic****