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Oncology I-IV

Oncology Side Effects, Hand& Foot Syndrome, Hypercalcemia, and Extravasation

TermDefinition
What is palmar-plantar erythrodysesthesia? - hand- foot syndrome - Chemo induced
what are the common chemo agents that cause hand-foot syndrome? S2C2FL - fluorouracil - capecitanine - cytarabine - liposomal doxorubicine - sorafenib - sunitinib
what are the common sxs of hand-foot syndrome? - redness - swelling - tenderness - pain - blister - peeling of the palms and soles
what are some management approaches of hand- foot syndrome in patient showing no improvement ? - delay the tx - reduce the chemo dose
how are the following sxs of chemo induced hand-foot syndrome managed? 1- temporary relief of pain and tenderness 2- moisturizing 3- alleviate inflammation and pain? 1- cooling compresses 2- emollients 3- steroid
what are some important patient counseling as PREVENTION to chemo induced hand-foot syndrome? - limit activity ( heat/ frication) 1 week after IV chemo ( fluorouracil) - limit activity ( heat/ friction) during the exposure ( capecitabine)
what are some important patient counseling as PREVENTION to chemo induced hand-foot syndrome? 1- avoid hot water 2- shower with warm/luke water 3- avoid using washing gloves 4- avoid increasing pressure activity on soles of feet and palms of hands
what are the common cancer types that increase the risk of hypercalcemia? - breast cancer - lung cancer - multiple myeloma
what are the common sxs of chemo induced hypercalcemia? - nausea/vomiting - fatigue - dehydration --> volume depletion --> renal failure - altered mental status
what is the goal of treating patient with chemo induced hypercalcemia? - hydration - chem ---> hypercalcemia --> intravascular volume depletion --> renal failure
What is the cutoff for mild, moderate and severe hypercalcemia? - mild: corrected Ca <12 + no sxs - moderate/severe : corrected Ca> 12 OR sxs
What is the management plan for patient with mild vs. moderate/severe chemo induced hypercalcemia? - mild: ORAL/IV normal saline - moderare/ severe: IV normal saline
what is the management steps in patient with chemo induced hypercalcemia? - hydration with normal saline - after correction of volume depletion -->start pt on LOOP diuretics - if pt is moderate/severe --> start pt on IV bisphosohonates or denosumab ( if pt can't tolerate or no response) - start calcitonin in sxs pt
why loop diuretics such as furosemide is given to pt with chemo induced hypercalcemia? - after correcting the patient hydration status using normal saline - loop diuretics helps with increasing the renal calcium excretion
When is the use of IV bisphosphonate is indicated? in patient with moderate/severe chemo induced hypercalcemia - corrected Ca>12 and/or sxs
what is an alternative to IV bisphosphonate in patient with chemo induced hypercalcemia? - denosumab --> for pt can't tolerate bisphosphonate OR no response to bisphosphonate therapy
when is the level of Ca expected to be lower after the use of IV bisphosphonate or Denosumab? within 1-3 days
what is the drug of choice to add to the current chemo induced hypercalciemia regimen in SXS patient ? - hydration + furosemide + denosumab or bisphosphonate - add Calcitonin ( as it lowers calcium within 2-6 hrs)
what is the important consideration in using calcitonin in chemo induced hypercalciemia patient? - TACHYPHYLAXIS --> sudden drop of response to the drug - happens 2/2 repeated dosing - goal is to limiti the use to only 48 hrs
what is resorption of bone ? - the break down the tissue in bones and release the minerals - resulting in a transfer of calcium from bone tissue to the blood.
what is the main MOA of loop diuretics & calcitonin in correcting Ca level in patient with chemo induced hypercalciuma? - Loop diuretics: increases the renal calcium excretion - calcitonin: inhibit resorption + increases renal excretion
why the use of calcitonin is limited to only 48 hours? because of tachyphylaxis risk
what is the recommended management in patient with moderate/severe chemo induced hypercalciemia? - hydration - loop diuretics - bisphosphonate or denosumab - start calcitonin no more than 48 hrs ( MAX DURATION IS 2 DAYS )
How the corrected calcium calculated? - corrected calcium= calcium ( reported) + {{( 4- albumin) * 0.8 mg/dL ]}
What is the recommended dose of calcitonin in moderate/severe hypercalcium chemo induced? - 4-8 units/Kg - IM/SC - Q 12hr
What are some example IV bisophosnates? (IV ROUTE) - zoledronic acid - Pamidronate
Why Zoledronic acid should be INFUSED OVER >>> 15 min? due to the risk of renal toxicity
what is the important consideration in using calcitonin in chemo induced hypercalciemia patient? - TACHYPHYLAXIS --> sudden drop of response to the drug - happens 2/2 repeated dosing - goal is to limiti the use to only 48 hrs
what is resorption of bone ? - the break down the tissue in bones and release the minerals - resulting in a transfer of calcium from bone tissue to the blood.
what is the main MOA of loop diuretics & calcitonin in correcting Ca level in patient with chemo induced hypercalciuma? - Loop diuretics: increases the renal calcium excretion - calcitonin: inhibit resorption + increases renal excretion
why the use of calcitonin is limited to only 48 hours? because of tachyphylaxis risk
what is the recommended management in patient with moderate/severe chemo induced hypercalciemia? - hydration - loop diuretics - bisphosphonate or denosumab - start calcitonin no more than 48 hrs ( MAX DURATION IS 2 DAYS )
How the corrected calcium calculated? - corrected calcium= calcium ( reported) + {{( 4- albumin) * 0.8 mg/dL ]}
What is the recommended dose of calcitonin in moderate/severe hypercalcium chemo induced? - 4-8 units/Kg - IM/SC - Q 12hr
What are some example IV bisophosnates? (IV ROUTE) - zoledronic acid - Pamidronate
Why Zoledronic acid should be INFUSED OVER >>> 15 min? due to the risk of renal toxicity
what makes zolderonic acid dosing in hypercalcemia ( zometa) different that zolderonic acid dosing in osteoporosis ( reclast)? Zometa: 4mg IV once OVER 15 min infusion --> can repeat every week ( hypercalciuma) Reclast: 5 mg IV Q year ( osteoporposis) *** if zolderonic acid is used to tx pt for hypercalciuma --> no renal adjustment needed in mild- moderate pt
what is the dosing of pamidronate ( Aredia) in patient with hypercalciuma? 60-90 mg IV over 2-24 hr may repeat in week
what is the recommended management in patient with mild chemo induced hypercalciemia? - hydration - loop diuretics - IV bisphosphonate
What is the MOA of Denosumab ( Xgeva) in patient with hypercalciuma? - blocks RANKL and RANK - inhibits the osteolcalst formation
what makes the dosing of denosumab ( Xgeva) in hypercalciuma different than osteoporosis ( prolia) dosing? - hypercalciuma: 120 mg SC ( day 1,8, 15 of 1st month) --> every month - osteoporsis: 60 mg SC every 6 months
what are some consideration while handling chemo drugs in particular vesicants? - vesicants induced extravasation - leakage of vesicants --> tissue necrosis ( extravasation) *** 1- deliver via central venous catheters *** 2- fresh started peripheral IV line
what are the two main vesicant drug classes? - anthracyclines - vinca alkaloids
what are some management tips of vesicant leaked during the administration step? - COLD compresses in all veiscants except 1- vinca alkaloids ( vincristine, vinblastine, vinorelbine) 2- etoposide
what is the antidotes of anthracyclines? - dexrazoxane ( totect)
what is the antidotes of vinca alkaloids? hyaluronidase
what is the IT administration? - intrathecally - inject drug into cerebrospinal fluid
what are some common drugs of IT administration? - cytarabine - methotreaxte - hydrocortisone - thiotepa
Which chemo drug should NEVER been given as IT? Vincristine - can cause ascending radiculo myeloencephalopathy ( damage to the brain's blood vessels and BBB), --> death
what are some recommendation to avoid accident vincristine IT injection ? - NEVER prepare vincristine in a syringe - ALWAYE prepare vincristine in IVPB solution ( 50-100ml)
what is the recommended vaccination schedule for patient receiving chemotherapy? - 2 weeks prior to chemo - inactivated flu vaccine between chemo cycle - AVOID live vaccine 2/2 pt is immunocompromised - live vaccine can be given after D/C chemo for at least 3 MONTHS
Created by: Smoham38
 

 



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