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BCPS study guide

Cancer Supportive care - PAIN and onc emergencies

QuestionAnswer
PO to IV conversion for morphine. theoretically 6:1 but clinically appears to be closer to 3:1
MOAs for NV with opioids and reasonable treatment options for each stimulation of chemoreceptor trigger zone. dopamine blockers such as phenothiazines would be appropriate. also vestibular component to NV so drugs that serve as antivertigo agents such as meclizine or dimenhydrinate would be appropriate.
cancers that may result in bone pain and ASCO recommended treatments multiple myeloma or breast cancer or with bone mets. pamidronate 90 mg or zolendronic acid 4 mg. treat until pt begins to have significant decline in performance status every 3-4 weeks. Can also use denosumab, a RANKL inhibitor that prevents bone removal
ADEs of bisphosphonates BRONJ, low grade fevers, nausea, anorexia, vomiting, hypomagnesemia, hypocalcemia, hypokalemia, nephrotoxicity
what drugs should pts take along with bisphosphonates calcium and vitamin D to avoid hypocalcemia.
what type of pain are antidepressants and anticonvulsants useful for neuropathic pain
what type of pain are corticosteroids used to treat nerve compression, inflammation, lymphedema, bone pain, increased ICP
Strontium-89 - use and important ADE a radionucleotide used for bone pain associated with osteoblastic lesions. caution as it is myelosuppressive
most common tumors associated with hypercalcemia lung, breast, multiple myeloma, head nd neck, renal cell, non-hodgkin lymphoma
equation for corrected calcium Corrected Ca=[(4-albumin)x0.8 + calcium]
symptoms of hypercalcemia lethargy, confusion, anorexia, nausea, constipation, polyuria, polydipsia
mild hypercalcemia and treatment <12 corrected calcium. can try hydration with NS followed by observation
moderate hypercalcemia and treatment 12-14 corrected calcium. basic treatment of clinical symptoms
severe hypercalcemia and treatment >14 and symptomatic. hydration with NS of 3-6 L in 24 hours, loop diuretic, bisphosphonates prevent dissolution by phosphatases and inhibit bone resporbtion, calcitonin inhibits PTH, steroids lower calcium in steroid responsive tumors, dialysis if RF.
treatment of spinal cord compression dexamethasone and radiation therapy or surgery
treatments for TLS hydration with NS, allopurinol and possibly rasburicase
electrolyte disturbances with TLS hyperuricemia, hyperkalemia, hyperphosphatemia, secondary hypocalcemia,
Created by: mjuhlin