Cancer Supportive care - PAIN and onc emergencies
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| PO to IV conversion for morphine. | theoretically 6:1 but clinically appears to be closer to 3:1
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| 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.
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| 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
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| ADEs of bisphosphonates | BRONJ, low grade fevers, nausea, anorexia, vomiting, hypomagnesemia, hypocalcemia, hypokalemia, nephrotoxicity
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| what drugs should pts take along with bisphosphonates | calcium and vitamin D to avoid hypocalcemia.
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| what type of pain are antidepressants and anticonvulsants useful for | neuropathic pain
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| what type of pain are corticosteroids used to treat | nerve compression, inflammation, lymphedema, bone pain, increased ICP
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| Strontium-89 - use and important ADE | a radionucleotide used for bone pain associated with osteoblastic lesions. caution as it is myelosuppressive
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| most common tumors associated with hypercalcemia | lung, breast, multiple myeloma, head nd neck, renal cell, non-hodgkin lymphoma
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| equation for corrected calcium | Corrected Ca=[(4-albumin)x0.8 + calcium]
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| symptoms of hypercalcemia | lethargy, confusion, anorexia, nausea, constipation, polyuria, polydipsia
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| mild hypercalcemia and treatment | <12 corrected calcium. can try hydration with NS followed by observation
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| moderate hypercalcemia and treatment | 12-14 corrected calcium. basic treatment of clinical symptoms
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| 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.
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| treatment of spinal cord compression | dexamethasone and radiation therapy or surgery
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| treatments for TLS | hydration with NS, allopurinol and possibly rasburicase
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| electrolyte disturbances with TLS | hyperuricemia, hyperkalemia, hyperphosphatemia, secondary hypocalcemia,
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