Flashcards in Exam 2- 6/7 Deck (49):
1
some known vesicants
anthracyclines (rubicines, vinca alkaloids, etc
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anthracylines MOA of tissue destruction
DNA binding
- binds with DNA of surrounding cells
- most toxic
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vinca alkaloids MOA of tissue destruction
non_DNA binding
- cause immediate cell destruction. have a shorter duration
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patient-related risk factors for extravasation
multiple venipunctures, very young or very old, heavily sedated patients, parathesias, inability to communicate
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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
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clinical presentation of extravasation
local pain and burning, swelling and erythema, lack of blood return, skin ulceration and skin necrosis
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sodium bicarb
increases pH, increases tissue uptake of anthracyclines
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glucocorticoids
- little to no inflammatory response has been found in tissues with extravasation
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anthracycline extravasation treatment
apply cold
- DMSO
- dexrazoxane
(one or the other)
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mechlorethamine extravasation treatment
appy cold
- 1/6M solution of sodium thiosulfate
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vinca alkaloids extravasation treatment
- apply HEAT
- hyaluronidase: breaks down SQ tissue to increase clearing
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tumors commonly associated with hypercalcemia
breast, multiple myeloma, lung, squamous cell cancer of head, neck, esophagus & female genital traction, NHL, leukemia, renal, cervical, colon
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corrected calcium formular
- correct when albumin less than 3.5
Ca+0.8 (4-albumin)
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osteolytic HCM
metastatic tumor cells release stuff that stimulates osteoclasts, osteoclasts release growth factors that stimular tumor growth
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SXS HCM GI:
constipation, N/V, anorexia
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SXS HCM renal:
polyuria, polydipsia, dehydration, decreased GFR
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SXS HCM neurological
lethargy and confusion, irritability, fatigue, muscle weakness, seizures, stupor, coma
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SXS HCM cardiac
shortened QT interval, widened T wave, heart block, asystole, arrhythmias
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3 basic interventions for HCM
- treat underlying malignancy
- DC drugs that increase serum Ca or decrease renal blood flow
- encourage ambulation
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mild HCM treatment
Ca less than 12 and asymptomatic
- oral fluids
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moderate HCM treatment
Ca 12-14 and symptomatic
- hydrate + lasix
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severe HCM treatment
Ca 14-16 regardless of symptoms
- treatment+ calcitonin
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HCM hydration
- NA 200-500ml/hr
- furosemide
- reduces Ca by 1.5-2.5; onset 12-24 hours
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HCM treatment
- bisphosphonates: zoledronic acid (better), pamidronate
- reduces ca by 2-4; onset 48 hours
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bisphosphonate MOA
- inhibit osteoclast recruitment
- induce osteoclast apoptosis
- inhibit/reduce osteoclast activity
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common bisphosphonate toxicity
bone pain, myalgia/arthralgia
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severe bisphosphonate toxicity
osteonecrosis of the jaw
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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
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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
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cancers with the highest risk of TLS
burkitt's lymphoma, lymphoblastic lymphoma, T cell ALL, AML
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TLS pathophys
- rapid lysis of tumor cells
- release of intracellular content
- exceeding ability for normal compensatory mechanism
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TLS finding
hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia
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clinical consequences of TLS
- acute renal failure
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TLS prevention
IV hydration
alkalinize urine- not recommended
allopurinol
rasburicase
close monitoring
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rasburicase
Elitek
- recombinant urate oxidase
- uric acid to allantoin
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rasburicase is contraindicated in
G6PD deficiency
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rasburicase BBW
anaphylaxis, hemolysis, methemaglobinemia
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rasburicase dosing
3mg vs 6mg
- use 6mg bc had less need for a repeat dose
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TLS monitoring
CBC, electrolytes, renal function, urine analysis, fluid intake and output
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TLS prevention for high risk
hydration , rasburicase
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TLS prevention for intermediate risk
hydration, allopurinol
- rasburicase may be considered in peds
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TLS prevention for low risk
clinical judgement and monitoring
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superior vena cava (SVC) syndrome SXS
dyspnea, tachypnea, cough, venous distension, facial or arm edema, chest pain, dysphagia, sensation of fullness in head, cyanosis
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causes of SVC syndrome
SCLC, NHL, hodgkins, head and neck cancer, thymoma, germ cell tumors, breast cancer
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SVC syndrome supportive measures
bed rest, oxygen, corticosteroid, diuretics, low salt diet
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SVC syndrome treatment
chemo, radiation, surgery, anticoag, thrombotics, catheter removal, stent
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spinal cord compression clinical presentation
pain
neuro symptoms
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spinal cord compression treatment
dexamethasone to reduce edema and delay onset of paraplegia
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