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Therapeutics P3 Spring > Oncologic Emergencies > Flashcards

Oncologic Emergencies Flashcards

1
Q

Metabolic Onco Emergencies

A

Hypercalcemia of Malignancy
Tumor lysis syndrome

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2
Q

Hematologic Onco Emergencies

A

Febrile Neutropenia

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3
Q

Tumor lysis syndrome: definition

A

large number of cancer cells rapidly die -> cell contents released in the blood
- DNA
- phosphate
- potassium
- cytokines

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4
Q

TLS: Cairo-Bishop definition

A

laboratory TLS: >/= of the following within 3 days before or 7 days after initiation of treatment
- hyperkalemia (>/=6)
- Hyperuricemia (>/=8)
- hyperphosphatemia (>/=4.5)
- Hypocalcemia (</= 7)

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5
Q

TLS: presentation

A

Hyperkalemia
- ECG abnormalities
- cardiac arrest
- fatigue
Hyperuricemia
- AKI
- crystal nephropathy
Hyperphosphatemia
- AKI
- GI upset
- AMS
Hypocalcemia
- AMS
- seizures
- arrhythmia
- tetany, spasms

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6
Q

TLS prevention

A

hold causative agents
- diuretics
- Ca / K / Phos supplements
- ACE
- nephrotoxic agents

Hydration

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7
Q

TLS Management

A

High risk
- hydration
- rasburicase
- allopurinol

Intermediate risk
- hydration
- allopurinol
- consider rasburicase

Low risk
- observation
- normal hydration

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8
Q

Allopurinol

A

Xanthine Oxidase inhibitor
for TLS prevention: initiate 24 hrs before chemo
Dose:
- 10 mg/kg/day div Q8H
- 300 mg PO QD

Caution:
- severe hypersensitivity rxn
- will not lower current uric acid levels

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9
Q

Rasburicase

A

Induces uric acid metabolism
Indication:
- pre-existing hyperuricemia
- high risk TLS
- spontaneous TLS
Dosing:
- 0.15-0.2 mg/kg/dose QD for up to 5d
- flat dose 1.5 or 3mg
Caution
- G6PD deficiency
- $$$

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10
Q

TLS: Hyperkalemia managment

A

Hydration
Severe or symptomatic ->
- calcium chloride 1g IV
- regular insulin 10U + IV dextrose 25g
- Sodium bicarb 50 mEq IV
- Sodium polystyrene 15-60 g PO
- Hemodialysis or CRRT

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11
Q

TLS: Hyperphosphatemia management

A

1st line IV hydration
decrease exogenous phosphate intake
last line: dialysis

phosphate binders
- calcium acetate
- calcium carbonate
- aluminum hydroxide
- lanthanum
- sevelamer

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12
Q

TLS: Hypocalcemia management

A

Typically resolves after hyperphosphatemia
only treat symptomatic (cardiac arrhythmias, seizures, tetany)

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13
Q

Febrile neutropenia definition

A

Febrile
- single temp >/= 38.8 C
- temp > 38 C for over 1 hr

Neutropenia
- ANC < 500
- ANC < 1000 and expected to be < 500 within 48h

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14
Q

FN: Low risk

A

standard chemo for most solid tumors
anticipated neutropenia < 7d
prophylaxis: nope

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15
Q

FN: Med risk

A

autologous HCT
lymphoma
multiple myeloma
CLL
purine analog therapy
anticipated neutropenia 7-10 days

Prophylaxis: consider bacterial, fungal or viral

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16
Q

FN: High risk

A

Allogenic HCT
Acute leukemia
Alemtuzumab therapy
GVHD therapy treated with high dose steroids
Anticipated neutropenia > 10 days

Prophylaxis: bacterial, fungal, viral

17
Q

FN: Antimicrobial prophylaxis

A

Levofloxacin
Ciprofloxacin

18
Q

FN: Antifungal prophylaxis

A

Fluconazole
Posaconazole
Voriconazole

19
Q

FN: Pneumocystitis jirovecci pneumoniae prophylaxis

A

Bactrim

20
Q

FN: Viral prophylaxis

A

Acyclovir

21
Q

FN prevention: colony stimulating factors

A

Pegfilgrastim
Filgrastim

22
Q

FN Risk assessment

A

MASCC score
High risk: < 21
- inpatient
- IV abx

Low risk: >/= 21
- outpatient management
- PO abx

23
Q

FN: MRSA coverage not recommended unless…

A
  • catheter related infections
  • SSTI
  • Pneumonia
  • Hemodynamic insufficiency/sepsis
  • mucositis
24
Q

FN: fungal coverage only added if…

A

no response to therapy within 4-7 days
positive fungal markers / culture

25
Q

Hypercalcemia of malignancy severity

A

Mild:
- corrected calcium 10.5-11.9

Moderate:
- corrected calcium 12-13.9

Severe:
- corrected calcium >/= 14

26
Q

Corrected calcium formula

A

Corrected Ca = measured Ca + [0.8 x (4 - albumin)]

27
Q

Hypercalcemia of malignancy: symptoms

A

Renal
- polyuria
- polydipsia
- dehydration
- decrease in GFR
GI
- constipation
- anorexia
- N/V
- acute pancreatitis
Neurologic
- lethargy
- confusion
- irritability
- muscle weakness
- seizure
- stupor
- coma
Cardiac
- shortened QT interval
- widened T wave
- heart block
- asystole
- atrial and ventricular arrhythmia

28
Q

Hypercalcemia of malignancy treatment

A

Hold Vit D, Ca, thiazide diuretics
Hydration: NS +/- furosemide
IV bisphosphonates
RANK-L inhibitors
2nd line:
- calcitonin
- glucocorticoids
- calcimimetics
- dialysis

29
Q

Hypercalcemia of malignancy: IV bisphosphonates

A

Agents:
- zoledronic acid
- pamidronate
Renal dose adj NOT RECOMMENDED
Can take 7 days to full effect
ADE:
- flu like sx (APAP prophylaxis)
- fevers
- arthralgias
- nephrotoxicity

30
Q

Hypercalcemia of malignancy: RANK-L inhibitors

A

Denosumab
can take 9-10 days to full effect
used for hypercalcemia refractory to bisphosphonates

Therapeutics P3 Spring (32 decks)

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