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30 Cards in this Set
- Front
- Back
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what is the serum calcium level defined as hypercalcemia
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serum calcium >10.5 mg/dl
ionized calcium > 1.29 in presence of malignancy |
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what is the most common tyep of hypercalcemia associated with cancer and what causes it
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humoral hypercalcemia of malignancy due to PTHrP
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what hormones are involved in hypercalcemia associated with cancer
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PTHrP
Activated Vit D3 |
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what are symptoms of hypercalcemia of malignancy dependent on
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rate of increase in calcium
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how do you treat a pt with hypercalcemia of malignancy
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adequate hydration
bisphosphonate (zolendronate) loop diuretics calcitonin |
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what are some meds known to cause an increase in serum Ca
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thiazides
lithium vit d/calcitriol |
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why is hydration important in treatment of hypercalcemia of malignancy
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if pt is volume depleted that decreases their GFR and ability to excrete excess Ca
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when would you use loop diuretics in treating a patient with hypercalcemia malignancy
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after hydration status has been corrected
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if a patient has hypercalcemia malignancy due to activated Vit D3 what agent should you give them
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glucocorticoids
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why is calcitonin given along with bisphosphonate
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it takes the bisphophonate (zoledronic acid) a long time to work and calcitonin works rapidly and has a short duration so can be given in the mean time
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TLS can occur spontaneously in what tumors with rapid growth pattern like
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burkitt lymphoma
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when is TLS most commonly seen
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after chemotherapy
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what are some of the things released upon lysing a malignant cell
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hyperkalemia
hyperphosphatemia hypocalcemia hyperuricemia |
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what are the lab definitions of TLS (>=2 lab changes)
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uric acid - >=8 or 25% increase
potassium >= 6 or 25% increase phosphorous >= 6.5 or 25% increase calcium - <=7 or 25% decrease |
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what are the clinical definitions of TLS (lab TLS and one or more of the following)
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serum creatinine > 1.5x ULN
cardiac arrhythmia or sudden cardiac death seizure |
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what TLS risk NHL high/intermediate
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HIGH:
burkits B-ALL INTERMEDIATE: DLBCL |
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what TLS risk ALL high/low
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HIGH:
WBC > 100k LOW: WBC < 50K |
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what TLS risk AML HIGH/LOW
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HIGH:
WBC> 50K LOW: WBC <10K |
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what risk category do solid tumor patients fall into
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low risk category
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in TLS how do you treat Hyperkalemia (K >7-7.5)
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asymptomatic:
SPS, loops symptomatic: calcium gluconate to stabilized heart plus agents to decrease serum K |
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if a pt with TLS has hyperK what agents should they not be on
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spironolactone
Ace -I these agents increase K |
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what agents can be given to move K intracellularly (intracellular K uptake)
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insulin
dextrose albuterol sodium bicarb |
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if a pt with TLS has hyperphosphatemia what can be given to treat
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asymptomatic
-hydration -phosphate binders (calcium acetate, aluminum hydroxide, sevelamer) severe cases -hemodialysis |
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if a pt with TLS has hypocalcemia what can be given to treat
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asymptomatic
-no treatment just management of hyperphosphatemia symptomatic (tetany, paresthesias) -calcium gluconate |
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in patients with intermediate risk and high risk what can be given for prevention
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IV hydration
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what patients are allopurinol and rasburicase used in
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allopurinol - intermediate risk
rasburicase - high risk/intermediate risk pediatric patients |
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at what uric acid level would you not be able to use allopurinol
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>=7.5
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what are limitation of allopurinol
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will not decrease uric acid produced prior to therapy
decreases clearance of purine drugs (6mercaptupurine, azathioprine) |
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what is the MOA of rasburicase
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catalyzes NEW and EXISTING uric acid to allantoin (5x more soluble than uric acid)
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what is the hyperuricemia treatment algorithm for high, intermediate, and low risk patients
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HIGH - hydration + rasburicase
INTERMEDIATE - hydration + allopurinol (rasburicase if pediatric) LOW - clinical judgement +/* hydration |
