VTE 1
T/F - routine thromboprophylaxis is recommended for all outpt w/ cancer
F - need to weigh risks/benefits
- high risk pt receive apixaban, rivaroxaban or LMWH
- intermediate risk: apixaban or rivaroxaban
apixaban vs LMWH in treatment of VTE
- apixaban associated w/ low major bleeding and VTE recurrence rates
- 10mg bid x 7 days then 5mg bid x 6mnths
- also seen noninferiority
what are the offending chemo agents
anthracyclines and taxanes
presentation of hypercalcemia
bones, stones, moans, groans, overtones, cardiac (shortened qt, arrhythmia), renal (polyuria, polydipsia, dehydration)
diagnosis of spinal cord compression
MRI
prophylaxis for high risk outpatient
apixaban 2.5mg bid
rivaroxaban 10mg qd
LMWH 40mg subq qd
treatment of est VTE in cancer pt (3-6mnths)
can also use LMWH
aceniform rash offending agents
EGFR inhibitors, multikinase inhibitors, MEK inhibitors, mTOR inhibitors
how to calculate corrected ca
tot serum ca + 0.8 (4-serum albumin)
treatment of spinal cord compression
- corticosteroids (low dose)
- radiation or surgery
how long should prophylaxis be continued for post op in cancer pt
and which pt qualify for longer therapy
7-10days and some pt up to 4wks
- major open or laparoscopic abd surgery, prev thrombosis, anesthesia >2hrs, advanced stage disease, bed rest >4days, >60y/o, obese
T/F - pt undergoing laparotomy, laparoscopy, thoracotomy <30min should receive prophylaxis
F <30min
paronychia management
- mild: white vinegar and water soaks, topical steroids, po anti inflammatory meds or antibiotics (tetracyclines)
- severe: surgical excision, electrocautery or chemical cauterization (liquid nitrogen or silver nitrate)
if fluids do not fix hypercalcemia, what is the next treatment step
- zoledronic acid 4mg IV over 15min --> better ca lowering effects
- pamidronate 60-90mg IV over 2-24hrs
onset of action: 2-4 days, nadir after 7 days
DNA vs non DNA binding vesicants
- DNA binding causes cyclic cell death, necrosis of area
- non DNA binding damages one cell then tissue can neutralize drug so surrounding cells are protected
treatment of est VTE (initially) - dosing
- UFH: 80u/kg bolus then 18u/kg
- LMWH: 1mg/kg subq q12 or 1.5mg/kg subq qd
- riv 15mg q12 x 21 days
- apex 10mg bid x 7 days
pharmacologic prophylaxis in surgery
- UFH: 5000U subq 2-4h pre op and q8 after
- LMWH: 40mg subq 2-4hrs pre op and 40mg qd after
- LMWH: preferred unless crcl <30ml/min
HFS offending agents
- capecitabine
- 5FU
- liposomal doxorubicin
- cytarabine
- docetaxel
corticosteroids for hypercalcemia
pre 40-100mg po qd
onset 3-5 days
examples of vesicants (DNA and non DNA binding)
- non DNA binding: docetaxel, paclitaxel, vinca alkaloids
- DNA binding: anthracyclines
treatment of est VTE long term treatment dosing
- LMWH 1mg/kg subq q12 ro 1.5mg/kg subi qd
riv 20mg po qd
apix 5mg bid
LMWH vs warfarin
LMWH more effective in reducing risk of recurrent VTE w/o incr risk of bleeding
HFS treatment
- urea 20% and clobetasol 0.05% creams bid
- pain control w/ NSAIDs or topical anesthetics
- cool hands/feet using ice packs or wet towel
presentation of malignant spinal cord compression
- back pain (precedes neurologic symptoms)
- motor weakness, sensory impairment, autonomic dysfunction
what type of reaction do taxanes cause
- non IgE mediated
- present after 1-2 doses
- reaction caused by drug vehicle
- premeds
- rechallenge w/ premeds