Gpc Supportive Care Ii -Bms

Front 1

Normal RBC count

Back 1

4.6-6.2 x 10^6/mm3

Front 2

Normal WBC count

Back 2

4,800-10,800/mm3

Front 3

Normal platelet count

Back 3

140,000-440,000/mm3

Front 4

What is the absolute neutrophil count equation?

Back 4

ANC = WBC x %granulocytes (Segs + Bands)

Front 5

Definition of neutropenia

Back 5

ANC <500/mm3

Front 6

Definition of thrombocytopenia

Back 6

Platelet count <100,000/mm3

Front 7

What does NADIR mean? When does it occur? When does it recover?

Back 7

Nadir is a term used to describe the lowest value of the ANC that the blood count falls to during a cycle of chemo.
Usually occurs about 10-14 days after chemo.
Counts recover by 2-4 weeks after chemo.

Front 8

To administer chemo, a patient should have these values...

Back 8

ANC >1500/mm3 or WBC >3000/mm3
AND
Platelets >100,000/mm3

Front 9

Definition of febrile neutropenia

Back 9

ANC ≤ 500/mm3 + Temp. ≥ 101˚F (≥38.3˚C) of a single oral temperature OR
ANC ≤ 500/mm3 + Temp. > 100.4˚F (≥38.0˚C) for at least 1 hour.

Front 10

Patients with febrile neutropenia are considered high risk if they have these features... (5 things)

Back 10

ANC <100/mm3
Abnormal chest x-ray
Severe renal or hepatic dysfunction
Malignancy in remission
Any cormorbid conditions which require hospitalization

Front 11

Low-risk patients with febrile neutropenia should receive

Back 11

Ciprofloxacin + Augmentin (amoxicillin-clavulanate)

Front 12

If patients with febrile neutropenia have persistent fever, consider adding...

Back 12

Broader spectrum antibiotics
Antifungals
Antivirals

Front 13

High Risk Patients with Febrile Neutropenia (No vanco required)
Antibiotic Monotherapy

Back 13

Carbapenem OR
Antipseudomonal penicillin

Front 14

High Risk Patients with Febrile Neutropenia (No vanco required)
Antibiotic Dual Therapy

Back 14

Aminoglycoside PLUS
Carbapenem OR
Antipseudomonal penicillin

Front 15

High Risk Patients with Febrile Neutropenia (Vanco Required) Antibiotic therapy

Back 15

Vancomycin PLUS
Carbapenem +/- Aminoglycoside
Antipseudomonal penicillin +/- Aminoglycoside

Front 16

If overal infection risk is high and patient is taking Alemtuzumab, they should prophylax with...

Back 16

Septra

Front 17

If chemotherapy regimen has a incidence of febrile neutropenia of >20%, use this agent for prophylaxis

Back 17

Colony Stimulating Factors (CSF)

Front 18

Which agents have been proven to reduce the incidence, magnitude and duration of neutropenia following chemotherapy and bone marrow transplantation?

Back 18

G-CSF (filgrastim/Neupogen)
GM-CSF (sargramostim/Leukine)

Front 19

Avoid concomitant use of CSF during which therapies

Back 19

Chemotherapy AND Radiotherapy

Front 20

When should CSF be started after completion of chemotherapy administration?

Back 20

CSF should be started 24 hours after completion of chemotherapy administration

Front 21

Which CSF has evidence for reduction in infection related mortality?

Back 21

G-CSF (filgrastim/Neupogen)

Front 22

Filgrastim and sargramostim should not be administered in the period _____before til ____ after administration of chemotherapy

Back 22

24 hours
24 hours

Front 23

Pegfilgrastim should not be administered in the period ____ before til ____ after the administration of chemotherapy

Back 23

14 days before
24 hours after

Front 24

Most centers treat with CSF until ANC levels are

Back 24

ANC ≥ 2000-3000/μl

Front 25

G-CSF brand and generic names

Back 25

Neupogen
filgrastim

Front 26

GM-CSF brand and generic names

Back 26

Leukine
sargramostim

Front 27

PEG-G-CSF brand and generic names

Back 27

Neulasta
pegfilgrastim

Front 28

Neupogen dose

Back 28

5mcg/kg SC inj. QD

Front 29

Leukine dose

Back 29

250mcg/m2 SQ inj. QD (approx. 5mcg/kg)

Front 30

Neulasta dose

Back 30

single 6mg SC dose administered 24 hours post chemotherapy

Front 31

How should you decide whether pegfilgrastim or filgrastim should be used?

Back 31

Expected duration of neutropenia
(one dose of pegfilgrastim lasts longer than filgrastim)

Front 32

What is the main adverse effect of filgrastim?

Back 32

Medullary bone pain

Front 33

What are some of the patient risk factors for developing febrile neutropenia?

Back 33

Older patient >65 years
Previous chemo or radiation therapy
Pre-existing neutropenia or bone marrow involvement in tumor
Preexisting conditions (neutropenia, infection/open wounds, recent surgery)
Poor performance status
Poor renal function
Liver dysfunction

Front 34

Patient at high risk (>20%) for febrile neutropenia before first chemotherapy cycle[regardless of chemotherapy intent]

Back 34

CSF (category 1 for G-CSF)

Front 35

Patient at intermediate risk (10-20%) for febrile neutropenia before first chemo cycle

Back 35

Consider CSF

Front 36

Patient at intermediate risk (<10%) for febrile neutropenia before first chemo cycle

Back 36

Do not use CSF

Front 37

Patient presents with febrile neutropenia and has received filgrastim or sargramostim for prophylaxis. How should you manage their febrile neutropenia?

Back 37

Continue CSF (filgrastim or sargramostim)
If low risk --> PO antibiotics
If high risk --> IV antibiotics

Front 38

Patient presents with febrile neutropenia and has received prophylaxis with pegfilgrastim. How should they be treated?

Back 38

No addional CSF
If low risk --> PO antibiotics
If high risk --> IV antibiotics

Front 39

Patient presents with febrile neutropenia, did not receive CSF prophylaxis and has NO risk factors for infection associated complication. How should they be treated?

Back 39

No CSF
Since low risk--> PO antibiotics [Cipro + Augmentin]

Front 40

Patient presents with febrile neutropenia, did not receive CSF prophylaxis and has risk factors for infection associated complication. How should they be treated?

Back 40

Give CSF
Since high risk--> IV antibiotics

Front 41

What are the patient risk factors for poor clinical outcomes or for developing infection-associated complications?

Back 41

Sepsis syndrom
Age >65 yo
Sever neutropenia (ANC <100/mcl)
Neutropenia expected to last more than 10 days
Pneumonia
Invasive fungal infection
Other clincically documeted infections
Hospitalization at time of fever
Prior episode of febrile neutropenia

Front 42

What are the causes of cancer-related anemia?

Back 42

Blood loss
Abnormal angiogenesis
Malnutrition or decreased body stores of vitamin B12, iron, or folic acid

Front 43

What are the causes of chemotherapy-induced anemia?

Back 43

BMS (caused by chemo)
Nephrotoxicity (decreased erythropoetin production or activity)

Front 44

What are the adverse effects of Erythropoesis Stimulating Agents (ESA)?

Back 44

Thrombosis
Seizure
Hypertension
Increased mortality (in cancer-induced anemia)
Pure red cell aplasia (PRCA)

Front 45

What is pure red cell aplasia (PRCA)?

Back 45

A condition in which RBC precursors in bone marrow are nearly absent, while WBC and platelet precursors are usually present at normal levels.

Front 46

In which patients are Erythopoesis Stimulating Agents recommended?

Back 46

Myelosuppressive-chemotherapy induced anemia when cancer treatment goals are not curative and who have high symptomatic anemia risk.

Front 47

Erythropoetin
Brand names

Back 47

EPO: epoetin-α, Epogen, Procrit

Front 48

Darbepoetin alfa
brand name

Back 48

Aranesp

Front 49

Aranesp

Back 49

Darbepoeitin alfa

Front 50

What is the advantage of darbepoetin alfa over erythropoetin?

Back 50

Greater metabolic stability --> three-fold longer half life

Front 51

Should ESA (erythropoetin, darbepoetin alfa) be used for cancer related anemia?

Back 51

No. ESA use is not recommended because it shortens overall survival and time-to-tumor progression

Front 52

Patient has myelosupressive chemotherapy induced anemia and immediate correction is required. How should they be treated?

Back 52

Transfuse as indicated
Then perform complete physical assessment to assess if patient is asymptomatic or symptomatic

Front 53

Patient has myelosuppressive chemotherapy-induced anemia and immediate correction is not required. What do you do next

Back 53

Determine cancer treatment goals (curative or non-curative intent)

Front 54

Patient has chemotherapy-induced anemia, immediate correction is not required, and curative intent. What treatment can you not use?

Back 54

ESA is not indicated

Front 55

Patient has chemotherapy-induced anemia, immediate correction is not required, and has chemotherapy non-curative intent. What do you do next?

Back 55

Risk/benefit ratio
ESAs may be appropriate based on thorough risk/benefit discussion and patient preference.
Then perform Complete symptom assessment