Exam 2- 6/7

Question 1

some known vesicants

Answer 1

anthracyclines (rubicines, vinca alkaloids, etc

Question 2

anthracylines MOA of tissue destruction

Answer 2

DNA binding

• binds with DNA of surrounding cells
• most toxic

Question 3

vinca alkaloids MOA of tissue destruction

Answer 3

non_DNA binding

- cause immediate cell destruction. have a shorter duration

Question 4

patient-related risk factors for extravasation

Answer 4

multiple venipunctures, very young or very old, heavily sedated patients, parathesias, inability to communicate

Question 5

prevention strategies

Answer 5

central venous catheters, flexible catheters, repeat punctures should be proximal to prior, admin IV push through free flowing IV if given peripherally, check for frequent blood return during infusion, site is important, patient education

Question 6

clinical presentation of extravasation

Answer 6

local pain and burning, swelling and erythema, lack of blood return, skin ulceration and skin necrosis

Question 7

sodium bicarb

Answer 7

increases pH, increases tissue uptake of anthracyclines

Question 8

glucocorticoids

Answer 8

• little to no inflammatory response has been found in tissues with extravasation

Question 9

anthracycline extravasation treatment

Answer 9

apply cold
- DMSO
- dexrazoxane
(one or the other)

Question 10

mechlorethamine extravasation treatment

Answer 10

appy cold

- 1/6M solution of sodium thiosulfate

Question 11

vinca alkaloids extravasation treatment

Answer 11

• apply HEAT

- hyaluronidase: breaks down SQ tissue to increase clearing

Question 12

tumors commonly associated with hypercalcemia

Answer 12

breast, multiple myeloma, lung, squamous cell cancer of head, neck, esophagus & female genital traction, NHL, leukemia, renal, cervical, colon

Question 13

corrected calcium formular

Answer 13

• correct when albumin less than 3.5

Ca+0.8 (4-albumin)

Question 14

osteolytic HCM

Answer 14

metastatic tumor cells release stuff that stimulates osteoclasts, osteoclasts release growth factors that stimular tumor growth

Question 15

SXS HCM GI:

Answer 15

constipation, N/V, anorexia

Question 16

SXS HCM renal:

Answer 16

polyuria, polydipsia, dehydration, decreased GFR

Question 17

SXS HCM neurological

Answer 17

lethargy and confusion, irritability, fatigue, muscle weakness, seizures, stupor, coma

Question 18

SXS HCM cardiac

Answer 18

shortened QT interval, widened T wave, heart block, asystole, arrhythmias

Question 19

3 basic interventions for HCM

Answer 19

• treat underlying malignancy
• DC drugs that increase serum Ca or decrease renal blood flow
• encourage ambulation

Question 20

mild HCM treatment

Answer 20

Ca less than 12 and asymptomatic

- oral fluids

Question 21

moderate HCM treatment

Answer 21

Ca 12-14 and symptomatic

- hydrate + lasix

Question 22

severe HCM treatment

Answer 22

Ca 14-16 regardless of symptoms

- treatment+ calcitonin

Question 23

HCM hydration

Answer 23

• NA 200-500ml/hr
• furosemide
• reduces Ca by 1.5-2.5; onset 12-24 hours

Question 24

HCM treatment

Answer 24

• bisphosphonates: zoledronic acid (better), pamidronate

- reduces ca by 2-4; onset 48 hours

Question 25

bisphosphonate MOA

Answer 25

- inhibit osteoclast recruitment - induce osteoclast apoptosis - inhibit/reduce osteoclast activity

Question 26

common bisphosphonate toxicity

Answer 26

bone pain, myalgia/arthralgia

Question 27

severe bisphosphonate toxicity

Answer 27

osteonecrosis of the jaw

Question 28

other HCM treatment

Answer 28

add calcitonin for rapid reduction of calcium - reduces Ca by 1; onset 1-4 hours - do not use for mare than 5 days - salmon calcitonin more potent

Question 29

Tumor lysis syndrome (TLS) risk factors

Answer 29

- tumor with high proliferative rate - tumor sensitive to cytotoxic therapy - largetumor masses - leukocytosis - high LDH - pre-existing renal insufficiency - hematologic malignancies

Question 30

cancers with the highest risk of TLS

Answer 30

burkitt's lymphoma, lymphoblastic lymphoma, T cell ALL, AML

Question 31

TLS pathophys

Answer 31

- rapid lysis of tumor cells - release of intracellular content - exceeding ability for normal compensatory mechanism

Question 32

TLS finding

Answer 32

hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia

Question 33

clinical consequences of TLS

Answer 33

- acute renal failure

Question 34

TLS prevention

Answer 34

``` IV hydration alkalinize urine- not recommended allopurinol rasburicase close monitoring ```

Question 35

rasburicase

Answer 35

Elitek - recombinant urate oxidase - uric acid to allantoin

Question 36

rasburicase is contraindicated in

Answer 36

G6PD deficiency

Question 37

rasburicase BBW

Answer 37

anaphylaxis, hemolysis, methemaglobinemia

Question 38

rasburicase dosing

Answer 38

3mg vs 6mg | - use 6mg bc had less need for a repeat dose

Question 39

TLS monitoring

Answer 39

CBC, electrolytes, renal function, urine analysis, fluid intake and output

Question 40

TLS prevention for high risk

Answer 40

hydration , rasburicase

Question 41

TLS prevention for intermediate risk

Answer 41

hydration, allopurinol | - rasburicase may be considered in peds

Question 42

TLS prevention for low risk

Answer 42

clinical judgement and monitoring

Question 43

superior vena cava (SVC) syndrome SXS

Answer 43

dyspnea, tachypnea, cough, venous distension, facial or arm edema, chest pain, dysphagia, sensation of fullness in head, cyanosis

Question 44

causes of SVC syndrome

Answer 44

SCLC, NHL, hodgkins, head and neck cancer, thymoma, germ cell tumors, breast cancer

Question 45

SVC syndrome supportive measures

Answer 45

bed rest, oxygen, corticosteroid, diuretics, low salt diet

Question 46

SVC syndrome treatment

Answer 46

chemo, radiation, surgery, anticoag, thrombotics, catheter removal, stent

Question 47

spinal cord compression clinical presentation

Answer 47

pain | neuro symptoms

Question 48

spinal cord compression treatment

Answer 48

dexamethasone to reduce edema and delay onset of paraplegia

Question 49

treatment of choice for spinal cord compression

Answer 49

radiation