Exam 2- 6/7 Flashcards Preview

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Flashcards in Exam 2- 6/7 Deck (49):
1

some known vesicants

anthracyclines (rubicines, vinca alkaloids, etc

2

anthracylines MOA of tissue destruction

DNA binding
- binds with DNA of surrounding cells
- most toxic

3

vinca alkaloids MOA of tissue destruction

non_DNA binding
- cause immediate cell destruction. have a shorter duration

4

patient-related risk factors for extravasation

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

5

prevention strategies

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

6

clinical presentation of extravasation

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

7

sodium bicarb

increases pH, increases tissue uptake of anthracyclines

8

glucocorticoids

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

9

anthracycline extravasation treatment

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

10

mechlorethamine extravasation treatment

appy cold
- 1/6M solution of sodium thiosulfate

11

vinca alkaloids extravasation treatment

- apply HEAT
- hyaluronidase: breaks down SQ tissue to increase clearing

12

tumors commonly associated with hypercalcemia

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

13

corrected calcium formular

- correct when albumin less than 3.5
Ca+0.8 (4-albumin)

14

osteolytic HCM

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

15

SXS HCM GI:

constipation, N/V, anorexia

16

SXS HCM renal:

polyuria, polydipsia, dehydration, decreased GFR

17

SXS HCM neurological

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

18

SXS HCM cardiac

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

19

3 basic interventions for HCM

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

20

mild HCM treatment

Ca less than 12 and asymptomatic
- oral fluids

21

moderate HCM treatment

Ca 12-14 and symptomatic
- hydrate + lasix

22

severe HCM treatment

Ca 14-16 regardless of symptoms
- treatment+ calcitonin

23

HCM hydration

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

24

HCM treatment

- bisphosphonates: zoledronic acid (better), pamidronate
- reduces ca by 2-4; onset 48 hours

25

bisphosphonate MOA

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

26

common bisphosphonate toxicity

bone pain, myalgia/arthralgia

27

severe bisphosphonate toxicity

osteonecrosis of the jaw

28

other HCM treatment

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

29

Tumor lysis syndrome (TLS) risk factors

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

30

cancers with the highest risk of TLS

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

31

TLS pathophys

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

32

TLS finding

hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia

33

clinical consequences of TLS

- acute renal failure

34

TLS prevention

IV hydration
alkalinize urine- not recommended
allopurinol
rasburicase
close monitoring

35

rasburicase

Elitek
- recombinant urate oxidase
- uric acid to allantoin

36

rasburicase is contraindicated in

G6PD deficiency

37

rasburicase BBW

anaphylaxis, hemolysis, methemaglobinemia

38

rasburicase dosing

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

39

TLS monitoring

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

40

TLS prevention for high risk

hydration , rasburicase

41

TLS prevention for intermediate risk

hydration, allopurinol
- rasburicase may be considered in peds

42

TLS prevention for low risk

clinical judgement and monitoring

43

superior vena cava (SVC) syndrome SXS

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

44

causes of SVC syndrome

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

45

SVC syndrome supportive measures

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

46

SVC syndrome treatment

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

47

spinal cord compression clinical presentation

pain
neuro symptoms

48

spinal cord compression treatment

dexamethasone to reduce edema and delay onset of paraplegia

49

treatment of choice for spinal cord compression

radiation