Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
67 Cards in this Set
- Front
- Back
|
List ten conditions suggestive of a life expectancy less than or equal to 12 months.
|
1) Stage IV Cancer, 2) Performance Status of greater than or equal to 3, 3) Hypercalcemia, 4) Superior Vena Cava Syndrome, 5) Spinal Cord Compression, 6) Brain Metastasis, 7) Delirium, 8) Creatinine > 3, 9) Bilirubin > 2.5, & 10) Cahcexia (general ill health with emaciation, usually occurring in association with cancer or a chronic infectious disease).
|
|
|
What three pallative care problems are considered oncologic emergencies?
|
1) Hypercalcemia, 2) SVC, & 3) Cord Compression
|
|
|
What is the primary difference in the interventions/goals for a patient having an estimated life expectancy of years to months vs. one having merely months to weeks or weeks to days?
|
As the estimated life expectancy shifts from years to months to days, the goals shift from disease control to best supportive care, managing expectations, and providing guidance for the dying process.
|
|
|
Describe palliative pharmacological intervention for cachexia due to early satiety.
|
Metoclopramide can enhance gastric emptying to treat early satiety.
|
|
|
Describe two palliative pharmacological interventions for cachexia that stimulate appetite.
|
1) Megesterol 400 to 800 mg daily or 2) Prednisone 20 to 40 mg bid
|
|
|
What is the mechanism of action for megesterol?
|
A synthetic progestin with antiestrogenic properties which disrupt the estrogen receptor cycle. May stimulate appetite by antagonizing the metabolic effects of catabolic cytokines.
|
|
|
What are the indications for megesterol?
|
Palliative treatment of breast and endometrial carcinoma; treatment of anorexia, cachexia, or unexplained significant weight loss in patients with AID (acute infections disease?).
|
|
|
What is the dosing of megesterol?
|
400 to 800 mg daily
|
|
|
What dosage adjustments are required for megesterol?
|
None
|
|
|
What are the common adverse effects of megesterol?
|
Break through bleeding in women, vasomotor symptoms, diarrhea, edema
|
|
|
What rare but serious adverse effects are associated with megesterol?
|
Thromboembolic events, adrenal suppression, exacerbation of diabetes
|
|
|
What drug interactions are associated with megesterol?
|
Dofetilide, megesterol increases concentration, avoid.
|
|
|
Is a milligram of the oral form of megesterol equivalent to a milligram of a suspension formulation?
|
No
|
|
|
What are 8 causes of nausea in late stage, i.e. palliative care, cancer patients?
|
1) Opioids, 2) Intracranial Pressure (from brain mets), 3) Metabolic Problems, 4) Bowel Obstruction, 5) Constipation, 6) Peptic Ulcer Disease, 7) Autonomic Failure, & 8) Other Drugs
|
|
|
What treatments are utilized to treat nause and vomiting because of increased intracranial pressure due to brain mets?
|
1) Dexamethasone 4 to 8 mg bid or tid and/or 2) Palliative Radiation
|
|
|
What is the most frequent symptom associated with advanced cancer?
|
Fatigue/Asthenia
|
|
|
What are 8 causes of asthenia in late stage, i.e. palliative care, cancer patients?
|
1) Cachexia, 2) Cancer Treatment (chemotherapy, radiotherapy), 3) Anemia, 4) Psychological Distress, 5) Infection, 6) Metabolic Problems, 7) Pain and Opioid Treatment, & 8) Paraneoplastic Syndromes
|
|
|
What are six symptoms of delerium?
|
1) Cognitive failure, 2) Fluctuating levels of consciousness, 3) Changes in the sleep-wake cycle, 4) Psychomotor agitation, 5) Hallucinations, & 6) Delusions and other perception abnormalities
|
|
|
What are 7 causes of delerium in late stage, i.e. palliative care, cancer patients?
|
1) Opioid-induced neurotoxicity, 2) Brain tumour or metastasis, 3) Cancer treatment (chemotherapy, radiotherapy), 4) Psychotropic drugs, 5) Metabolic problems, 6) Sepsis, & 7) Paraneoplastic Syndromes
|
|
|
What is the first line therapy for delerium treatment?
|
Either 1) Haloperidol 0.5 to 2 mg po bid or 2) Olanzapine 2.5 to 7 mg po q2-4hr, Max dose 30 mg
|
|
|
What are 9 causes of dyspnea in late stage, i.e. palliative care, cancer patients?
|
1) Lung Tumour or Metastasis, 2) Pleural Effusion, 3) CHF, 4) Psychological Distress, 5) Anemia, 6) Pneumonia, 7) Muscle Weakness, 8) COPD, & 9) PE
|
|
|
List the treatment options for dyspnea in late stage cancer patients.
|
Oxygen, Opioids, Benzodiazepines, Corticosteroids, & Supportive Care [Dying patients often have excessive respiratory secretions. Scopolamine or Atropine are used to provide relief.]
|
|
|
What serum calcium range meets the criteria for "Mild Hypercalcemia of Malignancy?" Above what serum calcium levels is "Severe Hypercalcemia?"
|
Mild Hypercalcemia of Malignancy: Correctec Calcium = 12 to 13.5 mg/dL; Severe Hypercalcemia: Correctec Calcium > 13.5 mg/dL
|
|
|
What is the simple formula for calculating a corrected calcium?
|
Add 0.8 mg/dL to calcium for every gram of albumin less than 4 g/dL.
|
|
|
Describe the clinical presentation of hypercalcemia.
|
Confusion, Nausea and Vomiting, HA, Irritability, Muscle Weakness, & Coma
|
|
|
Describe pharmacologic therapy for hypercalcemia.
|
First, hydrate w/ 200 to 500 cc/hr IV saline. 20 to 40 mg IV furosemide (Lasix) is used to manage these fluids and to increase renal calcium excretion. Second, 250 mg Neutraphos PO QID (4x/day) until serum phosphorus normalizes above 3.0. First-line treatment beyond this include use of either pamindronate or zoledronic acid. Second-line agents include glucocorticoids, mithramycin, calcitonin, and gallium nitrate.
|
|
|
Describe use of glucocorticoids as a second-line treatment for hypercalcemia.
|
Prednisone 60 mg daily x 10 days
|
|
|
What adverse effects are associated with the use of prednisone to treat hypercalcemia in cancer patients?
|
Chemo Interference, Hypokalemia, & Hyperglycemia
|
|
|
Describe use of mithramycin as a second-line treatment for hypercalcemia.
|
25 micrograms/kg of body weight (single dose) in saline
|
|
|
What adverse effects are associated with the use of mithramycin to treat hypercalcemia in cancer patients?
|
Thrombocytopenia, Platelet-Aggregation Defect, Anemia, Leukopenia, Hepatitis, & Renal Failure
|
|
|
Describe use of calcitonin as a second-line treatment for hypercalcemia.
|
4 to 18 IU per kg SC or IM Q12 hr
|
|
|
By what mechanism of action does calcitonin work as a treatment of hypercalcemia?
|
Calcitonins causes a rapid shift of calcium from the plasma into cells, temporarily relieving the symptoms of hypercalcemia. [Works within 15 min.]
|
|
|
What adverse effects are associated with the use of calcitonin to treat hypercalcemia in cancer patients?
|
Flushing & Nausea
|
|
|
Describe the use of Gallium Nitrate as a second-line treatment for hypercalcemia.
|
100 to 200 mg/m^2 of BSA IV continuous x 5 days
|
|
|
What adverse effects are associated with the use of gallium nitrate to treat hypercalcemia in cancer patients?
|
Renal Failure
|
|
|
What is the mechanism of action for pamidronate?
|
Pamidronate is a bisphosphonate. It inhibits bone resportion and decreases mineralization by disrupting osteoclast activity.
|
|
|
What are the indications for pamidronate?
|
1) Moderate or severe hypercalcemia associated with malignancy, 2) Osteolytic bone lesions associated with multiple myeloma or metastatic breast cancer, & 3) Moderate-to-severe Paget's disease of bone
|
|
|
What is the common off label use of pamidronate?
|
Prevention of bone loss associated with androgen deprivation treatment in prostate cancer.
|
|
|
Describe dosing of pamidronate for moderate cancer-related hypercalcemia (corrected serum calcium 12 to 13.5 mg/dL).
|
60 to 90 mg, as a single dose over 2 to 24 hrs [Requires several days for effect: do not re-dose more than once a week!]
|
|
|
Describe dosing of pamidronate for severe cancer-related hypercalcemia (corrected serum calcium > 13.5 mg/dL).
|
90 mg, as a single dose over 2 to 24 hrs [Requires several days for effect: do not re-dose more than once a week!]
|
|
|
Describe dosing of pamidronate for osteolytic bone lesions.
|
90 mg every 4 months
|
|
|
Describe dosing of pamidronate for prevention of bone loss.
|
60 mg every 3 months
|
|
|
What dosing adjustments are required for pamidronate?
|
Discontinue if CrCL deteriorates with treatment.
|
|
|
What are the common adverse effects of pamidronate?
|
Fever, flu-like syndrome, NVD, electrolyte abnormalities, & increased creatinine
|
|
|
What rare but serious adverse effects are associated with pamidronate?
|
Severe muscle pain, osteonecrosis of the jaw, & atypical femur fractures
|
|
|
What drug interactions are associated with pamidronate?
|
Concurrent nephrotoxins (aminoglycosides, NSAIDs), monitor renal function
|
|
|
What is the mechanism of action for zoledronic acid?
|
Zoledronic acid is a bisphosphonate. It inhibits bone resorption via actions on osteoclasts or on osteoclast precursors.
|
|
|
What are the indications of zoledronic acid?
|
1) Moderate or severe hypercalcemia associated with malignancy; 2) Treatment of multiple myeloma, treatment of bone metastases of solid tumors; 3) Osteoporosis; & 4) Moderate-to-severe Paget's disease of bone
|
|
|
What are the common off label uses of zoledronic acid?
|
Prevention of bone loss associated with androgen deprivation treatment in prostate cancer and aromatase therapy with breast cancer.
|
|
|
Describe dosing of zoledronic acid for hypercalcemia.
|
4 mg IV as a single dose
|
|
|
Describe dosing of zoledronic acid for osteolytic bone lesions.
|
4 mg every 3 to 4 wks
|
|
|
Describe dosing of zoledronic acid for osteoporosis.
|
4 mg every 2 yrs
|
|
|
Describe dosing of zoledronic acid for prevention of bone loss.
|
4 mg every 3 to 6 months
|
|
|
What dosage adjustments are required for zoledronic acid?
|
For non oncology use, it is contraindicated if CrCL is < 35 mL/min. Use w/ caution in oncology patients having reduced CrCL.
|
|
|
What are the common adverse effects of zoledronic acid?
|
Fever, NVD, Electrolyte Abnormalities, & Increased Creatinine
|
|
|
What rare but serious adverse effects are associated with zoledronic acid?
|
Severe muscle pain, osteonecrosis of the jaw, & atypical femur fractures
|
|
|
What drug interactions are associated with zoledronic acid?
|
Concurrent nephortoxins (aminoglycosides, NSAIDs), monitor renal function
|
|
|
What is the maximum single dose of zoledronic acid?
|
4 mg
|
|
|
What is the name for zoledronic acid marketed for oncology indications? What is the name marketed for osteoporosis?
|
Zometa for oncology indications, Reclast for osteoporosis
|
|
|
What is SVC syndrome?
|
Obstruction of the superior vena cava (SVC) interrupts normal venous return of blood from the head, upper extremities, and thorax to the right atrium.
|
|
|
What are the symptoms of SVC?
|
Facial swelling, dyspnea, cough, distorted vision, orthopnea, horseness, stridor, nausea, HA, lightheadedness, & syncope
|
|
|
What life-threatening complications can develop from SVC syndrome?
|
Laryngeal or Cerebral Edema
|
|
|
What are the treatments for SVC syndrome?
|
Surgical Stenting, Radiotherapy, & Chemotherapy (determined by type of cancer causing SVC)
|
|
|
What are the presenting symptoms of spinal cord compression?
|
Pain, Weakness, Upper Motor Sensory Loss, & Loss of Sphincter Control
|
|
|
What are the treatments for spinal cord compression?
|
Steroids (Dexamethasone), Radiation to the affected area, & Chemotherapy (determined by type of cancer causing spinal cord compression)
|
|
|
Which patients may receive terminal sedation and under what circumstances is it used? [What is required?]
|
Patients with refractory symptoms for whom death is imminent (hours to days in the opinion of 2 physicians). [Requires advanced directive consent of the patient: no CPR, no life-prolonging interventions.]
|
|
|
Describe the two drug options for terminal sedation.
|
Option 1: Thiopental (initiate 20 to 80 mg/hr, range 160 to 440 mg/hr); Option 2: Midazolam (initiate 0.4 to 0.8 mg/hr, range 20 to 100 ???)
|
