Session 6: Oncology

Oncology

 

Review:

  • uncontrolled proliferation of cells in the body
  • Grade is the size of the tumor
  • Stage is the process for no metastasis to fully metastasized
  • Treatments: chemo, Radiation, biological (targeted), and surgery
  • Late vs. long term effects

 

  • be empathetic
  • When giving chemo, watch closely for extravasation.
    • If the medications given outside of the vessel the medication can cause major damage to the tissues.
    • If the med is given through a central line make sure the catheter is advanced the correct amount and not slid out at any point.
  • Radiation can cause burns to the skin and structures inside the body nearby the cancer location
    • Maintain skin integrity
    • Radiation can be external or implanted “seeds” for prostate cancer.
  • Biological targeted therapy
    • This type of therapy is often used first due to the higher specificity to the patient’s cancer and also tends to have fewer side effect.
  • ANC absolute neutrophil count
    • Important to keep a close eye on this during chemo because the level can drop rapidly.
    • Graded 1-4. 4 being the worst.
  • Oncologic emergencies
    • Sepsis
      • Temp above 100.4 degrees F
      • WBCs above 12000 or less than 4000
    • DIC
      • Monitor platelets, a drop indicated potential for DIC
    • SIADH
      • The tumor can produce ADH which causes retention of water.
      • Tumors can produce other hormones as well, but ADH is common and causes immediate issues.
      • These patients need to be on a water restriction.
      • Demecolcine can decrease the action of the ADH to help the patient urinate, and balance out their I’s and O’s
    • Spinal cord compression
      • Monitor for back pain which could be caused by a tumor pressing on the spinal cord
      • Treat immediately and this could cause paralysis
    • Hypercalcemia
      • A hormone similar to PTH can be secreted by cancer cells causing increased CA levels
    • Superior vena cava syndrome
      • The SVC is compressed be a tumor and the tumor must be removed to restore normal flow.
    • Tumor lysis syndrome
      • HyperK Ca phos, and uricemia
      • From the breakdown of a large number of tumor cells
  • Leukemia
    • Cancer of the blood cells usually white blood cells, and blood forming structures
    • This includes bone marrow, which will proliferate immature WBC’s
  • Lymphoma
    • Cancer of lymphocytes that also originate in the bone marrow.
    • Hodgkin’s disease – Reed-Sternberg cells
      • Most curable cancer
      • Lymph Nodes most commonly inflamed first, are around the neck and clavicles.
      • B symptoms indicate the progression of the disease from local to systemic.
        • The symptoms are: Fever, night sweats and more than 10% weight loss in less than six months.
    • Non Hodgkin’s Lymphoma –
      • Classifies all other lymphoid cancers without Reed-Sternberg cells.
      • Hallmark is painless enlarged node.
      • Full remission is uncommon.
      • B symptoms indicate the progression of the disease from local to systemic.
        • The symptoms are: Fever, night sweats and more than 10% weight loss in less than six months.
  • Multiple Myeloma
    • Proliferation of Plasma cells affecting the bone marrow and destroy bone
    • Treatable but not often curable.
    • First s/s is BONE PAIN, Pathologic fractures are common
    • Diagnosis with Monoclonal antibody, X-ray, increased bone marrow plasma cells, Beta 2-microglobulin and albumin.
    • Signs and symptoms – Babs the CRAB: HyperCalcemia, Renal failure, Anemia thrombocytopenia, and Bone pain
    • Hypercalcemia is due to high bone turnover causing pathological fractures
    • Renal failure is due to Monoclonal production of Ig
    • Anemia is due to the resources going to make cancerous plasma cells instead of regular RBCs and thrombocytes.
    • Bone pain is due to increased bone turnover

 

  • HACT
    • Replacing stem cells in a patient
    • Autologous Transplant is where the patient’s own bone marrow stem cells are collected, the patient goes through chemo and/or radiation, then the stem cells are put back so that they can start making blood cells again.
    • Allogeneic transplant is where a donor provides the bone marrow Stem cells for the patient.  
    • Prepare with immune protective measures
    • Bone marrow is stripped then replaced with healthy stem cells
    • The donor cell can be auto which means the donor is the patient previously, or
  • AML
  • Case 3 multiple myeloma
    • Leaking kidneys
    • Thirst
    • Creatinine

Multiple myeloma specific findings: high calcium levels and hence-jones protein in the urine

  • high priority – maintain high fluid intake to dilute calcium of 3-4L per day
  • Limiting movement will increase risk for pathological fractures

 

GM-CSF

  • can stimulate the production and function of neutrophils and monocytes

Leukemia patients are susceptible to infection even when they have a high white count because there is a left shift in the white cells and they are immature

 

Chemo induced anemia can cause activity intolerance due to hypoxia.

 

Stomatitis should be treated with a soft non irritating toothbrush and mouthwash to prevent further breakdown of the mouth.

 

Leukemia and bone marrow stem cells are eliminated in chemo and radiation for AML then a donor replaces the bone marrow stem cells through a transfusion

 

More Med cards!

Prednisone and Albuterol!

Sorry that these are a little late, but here are two of the next important medications that are focused on the lungs. The quick and dirty is that prednisone is a corticosteroid that will reduce inflammation if the lungs and is preventative therapy not a rescue drug. Albuterol is administered through an MDI and using a space will double the amount of med used by the lungs. Also it is a bronchodilator so if they are taken at the same time of day take the albuterol first then the prednisone so that the prednisone can be  more effective. Albuterol can be used as a rescue med. Any how here are the two med cards. PrednisoneAlbuterolInhaler.

Thanks for reading!

-Peter

Pharmacology class notes 3:

This was one of the most dense lectures yet! There is a huge amount of content and in some areas it is a little discontinuous. This may be an area to look over again in the book or on your slides. Take a look I hope that it can help you.

-Peter

Pharm

class 3

Respiratory Pharmacology

    1. asthma is a disorder causing reversible airway inflammation
      1. true
    2. what 4 things are inflammatory components particular in the patho of asthma?
      1. Histamines
      2. Leukotrienes and RBCs
  • histamines, leukotrienes, prostaglandins, interleukins
  1. if we cause beta receptor stim by epi what happens? to pulse.
    1. higher pulse
  2. what is the critical intervention to help prevent asthma attacks
    1. adherence to medication regimen
  3. what is the first medication that should be prescribed for an asthmatic?
    1. albuterol
  4. Which med is the most critical for prevention of  asthma?
    1. Glucocorticoid
  5. ms. jones is taking and OTC cold med and her PB is high. which medication can cause high BP
    1. Pseudoephedrine
  6. how do antihistamine stop coughs
    1. stops the post nasal drip
  7. 3 yo boy w/ cough how to teach parent about cold meds?
    1. Do not use cough meds in children under 6yo
  8. pt w/ tb comes in and shows bottle of INH what do you ask him
    1. Where are your other med bottles?
    • Relate the information that you know from patho and if something doesn’t make sense go back to patho and re learn the info
    • Asthma: bronchospasm and tightening (bronchoconstriction) , swollen and inflamed
      • s/s wheezing, cough, dypsnea
      • immune mediated
        • IgE mediated
      • Inflammation
        • Edema, mucus, Sm muscle hypertrophy, Bronchial hyperreactivity
          • we will try to prevent all these things w/ pharm
      • histamine – body produces in response to allergen
      • know the triggers of asthma
      • we want bronchodilation!
        • Beta2- agonists! (albuterol)
          • Epinephrine, albuterol, levalbuterol, -terol
          • bronchodilators,
  • Give this drug before the anti-inflammatory so the second drug can get to a higher % of the lungs
        • immediate symptom relief
        • can be used alone for minor intermittent asthma  
        • sites of action:
          • Lungs, legs, liver
        • Albuterol: Beta 2 – agonist
          • Long acting beta agonist
          • dilation, relaxes smooth mm
          • 5-30 min onset
          • peak 30-60min
          • duration 3-5 hours
          • adverse effects
            • hypergly, tremors, cardiac tachy and dysrhythmias
            • Theophylline (Uniphyl)
              • not first line, many side effects
                • lots of drug interactions
              • narrow TR
                • toxicity – seizures, Ventricular dysrhythmias  
        • Caffeine is a cousin to this drug and can relieve some symptoms
      • Anticholinergics
        • blocks Ach receptors causing bronchodilation
        • Tiotropium (Spiriva)
        • Aclidinium (Tudorza)
        • Approved for COPD only
        • anti- inflammatory
            • glucocorticoids (prednisone)-sone -lone
            • Prevention of acute asthma attack
            • foundation, taken daily
            • very effective
            • increase the # of beta 2 receptors
              • a lot of drugs have a tolerance building effect but these have the opposite effect?
        • first line agents for maintenance
            • Long term control
          • Leukotriene – modifiers. (zafirlukast(Accolate), montelukast(Singulair))
        • suppress effects of leukotrienes
        • preventive, not a rescue
        • blocks leukotriene receptors
        • alternatives to the inhaled steroids
        • side effects
          • boring: HA, and GI upset
      • OMALIZUMAB (Xolair)
        • expensive
        • antagonizes IgE

Approach to asthma

  • using a stepwise approach to increase the medication types as the Dx becomes more severe

MDI – 10% reaches lungs

  • spacer increases dose to lungs to about 21%
  • needs a propellant

Advair and symbicort

COPD

  • GOLD: global initiative for COPD
    • Reduce s/s improve health
    • reduce risks and mortality by preventing progression and exacerbation
  • Bronchodilators: LABA, (SABA in exacerbation)
  • glucocorticoids: w/ LABA

Rhinitis

  • inflammation of the nose
  • s/s sneezing, itching, watery eyes
  • Allergic reaction
    • histamine from allergen and IgE
  • Use antihistamines: H1 antagonists
    • 1st gen causes sedation (crosses BBB)
    • 2nd gen non-sedating
    • Mechanism of action: binds H1 receptors throughout body
      • blocks effects of histamine
    • blocks itching, blocks mucus secretions (thickens)
      • (will thicken secretions in asthma)

Non- alergic Rhinitis

  • common cold
  • Sympathomimetics/ decongestants
    • activates A-1 adrenergic receptors on nasal blood vessels -> vasoconstriction
    • high abuse potential
      • Pseudoephedrine, phenylephrine, Oxymetazoline
    • caution w/ HTN and COPD

Mucokinetic agents

  • dilute secretion, break down thick mucus
    • water or normal saline
  • acetylcysteine (musomyst)
    • unpleasant odor
    • for COPD, cystic fibrosis
    • quick onset <1min

expectorant

  • decrease viscosity of mucus, promotes secretions in the airways
  • Guaifenesin – found in many OTC
    • Not proven to be effective!!

Antitussive

  • relieve or prevent cough
    • dextromethorphan
      • effect cough center of medulla
      • abuse potential

TB – Mycobacteria

    • acid fast bacilli, waxy layer protects bacteria, slow growing
    • necrosis and cavitation of pockets of tissue
    • droplet transmission
    • drug therapy
      • 8 weeks INH, RIF, PZA, EMB
      • then: INH and RIF 2-3 times a week for 6 months or 12 in HIV patients
    • there is drug resistant TB and the drug therapy lasts 2 years
    • INH – isoniazid – kills active and latent sensitive TB
      • lots of side effects and they last for the whole 6 months
      • visual side effects KNOW SIDE EFFECTS FUUUUUCCCCKKK!!!
        • Hepatotoxicity: s/s of hepatitis• Peripheral neuropathies• GI distress, dry mouth, weakness• CNS: Sz, dizziness, ataxia,
    • Rifampin:
  • brown discoloration of body fluids, will stain contact lenses
  • Pyrazinamide
    • Ethambutol – only effective w/ actively dividing mycobacteria
  • decreased ability to see red and green
  • Commercial truck drivers will have issues with this and may not be able to work
Featured

Why we will kick ass at nursing school and the NCLEX

I will be using this blog to post anything my readers and I find helpful as we go through nursing school. This will be notes, flash cards, study guides and some helpful tips along the way. I am very excited to share this with you and I hope to improve our learning process and add another point of view on some of the new material to reach our goal of get better grades and passing the NCLEX!

Thank you for reading,

– Peter