1. Toxicity: Myelosuppression
    • Bone marrow suppression is common
    • look for:
    • Neutorpenia
    • Anemia
    • Thrombocytopenia
    • --Usually 12-14 days post administration
  2. Toxicities: Neutorpenia
    • ^risk of nfxn
    • v WBC and ANC
    • Fever >101. 
    • --Tx with antibiotics for min of 48hrs. 
    • --Tx with bone marrow growth factors
    • --Greatest risk is native bacteria in foreign places. Worst are gram- which travel through BS-->sepsis. Pt education on sepsis is vital, because otherwise they may not know to call MD or come in.
  3. How do you calculate ANC?
    Total WBC (neutrophil% plus bands)
  4. Toxicity: Anemia
    • Transfuse when Hgb<8, <10 if getting radiation.
    • Blood is filtered to remove WBC (WBCs may give pt feeling of general illness like flu)
    • Infuse total volume over 3-4hrs. 
    • Coordinate with radiation Tx.
  5. Toxicity: Thrombocytopenia
    • Apheresed (single donor) transfusion is preferred because multiple donors ^ risk of development of platelet antibodies
    • Infuse as rapidly as tolerated (30-60min), but DO NOT PUSH.
    • Platelet count <50K is really bad.
  6. Toxicity: GI
    • Stomatitis
    • N/V/C/D: if C, start on stool softener stat, because if thrombocytopenic, straining to stool may-->hemorrhage. 
    • anorexia
    • taste distortion
    • Past Hx of Type I herpes. If yes-->acyclovir. Always ask about cold sores/genital herpes. 
    • PCA pump w morphine, esp if mouth sores present. Will get better when WBC returns to normal.
  7. Toxicity: N/V
    • Serotonin-Antagonist agents most helpful 
    • --Ondansetron (Zofran)
    • --Granisetron (Kytril)
    • ----No dystonia, hallucinations, sedation
    • ----after 5 days, must switch anti emetics to another mechanism of action (Benadryl/Ativan) because serotonin receptors will be saturated and Rx will stop being effective. Will also prolong QT intervals-->TDP at high doses)
  8. Toxicity: Constipation
    • Usually caused by poor intake, but increase due to polypharm
    • Sepsis possible from seeding GI flora into blood stream. 
    • Stool softeners important
    • Very common in elderly
  9. Toxicity: Diarrhea
    • Breakdown of GI mucosa
    • Eradication of normal flora-->growth of opportunistic flora (C. Diff)
    • Tx with abx.
  10. Toxicity: Renal
    • E-lyte wasting
    • --Ca+, Phos, Mg++
    • v GFR-->v drug excretion 
    • Always assess fro preexisting renal disease because may Cx some therapies.
  11. Toxicity: Hepatic
    • Abd pain
    • Jaundice
    • Hepatomegaly
    • ^LFT
    • Hepatic fibrosis
    • *Very common in adults
  12. Toxicity: Pancreatic
    • Pseudo-Diabetes due to v insulin  production/secretion
    • --Monitor for SnSs of DM, especially if  also on steroids.
    • Monitor pancreatic enzymes (trypsin, amylase, lipase)
    • --Tx by NPO, NG tube, hydration, pain Rx. (Pain will cross midine if pancreas is source. Also, vomiting will not relieve symptoms).
  13. Toxicity: Coagluation
    • v anti-thrombin III levels + poor hydration-->^risk of clots. 
    • Consumption of clotting factors
    • Monitor for DIC, DVTs
  14. Toxicity: Neurologic
    • Paresthesias in fingers and toes (foot drop-->^fall risk)
    • Ataxic
    • Ptosis
    • Diminished DTRs
    • Cranial nerve dysfunction
    • SZR
    • SIADH
  15. Toxicity: Cardopulmonary
    • Cardiomyopathy/CHF
    • Abnormal PFTs
    • Pulmonary fibrosis
    • anaphylaxis
    • fluid shifts
    • opportunistic nfxn
    • --pneumocystis
    • --cytomegalovirus
    • *Preexisting comorbidities will greatly ^risk of cardiopulmonary complications.
  16. Toxicity: Reproductive
    • amenorrhea
    • impaired spermatogenesis (can be permanent if after puberty). 
    • premature menopause
    • contraception
    • reproductive alternatives, ie sperm banking?  
    • After treatment, go find a high-risk oncologist.
  17. What are some late effects of therapy?
    • Cognitive issues, aka "Chemobrain"
    • Chronic fatigue
    • Endocrine fnxn
    • Chronic neuropathy
    • Hearing loss
    • Bone demineralization can be accelerated by some Rx. 
    • Cardiopulmonary 
    • Recurrent malignancies (usually 10-15 years post regression)
  18. What are some biological and targeted therapies?
    • Interferon: inhibits DNA/RNA synthesis
    • Angiogenesis inhibitors: Avastin, Thalidomide-->reduce tumor's ability to create own vasculature. Will work on brain tumors because it can enter CSF
    • Hormone suppressant therapy
    • *adverse effects of biologic agents will generally be flu-like symptoms. More serious will be massive fluid shifts.
  19. What is precision therapy?
    Therapy targeting specific gene mutations.
  20. What are some of the major emergenies related to cancer
    • Cap leak ksyndrom
    • Superior vena cava syndrome
    • Spinal cord compression
    • Sepsis
    • Third spacing
    • Tumor lysis syndrome
  21. Hallmarks of cancer cells
    • Don't shut off, will not respond to anti-growth signals
    • Will evade apoptosis
    • Limitless reproductive potential (telomeres lose function)
    • Creates own blood supply
    • Will invade tissue and potential for metastasis
    • Inflammation caused by extrinisc nfxn
    • --ASA is also a good prophylaxis for various forms of cancer because chronic inflammation-->^risk cancer.
Card Set
Adult MedSurg 2