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Oncology Exam 2
Frei Neutropenia (A)
| Term | Definition |
|---|---|
| What is the definition of Neutropenia? | Condition in which there is a deficient number of neutrophils |
| A pt is considered to have neutropenia when their ANC (absolute neutrophil count is < _______ cells/mm^3 | 1500 *serious risk of infection occurs when ANC < 500 cells/mm^3 |
| How do you calculate an ANC (absolute neutrophil count)? | WBC x % neutrophils *CBC are often ordered with differential (CBC gives white count into different subtypes (neutrophils, and %) |
| Example: WBC 3.5 x 10^3/mm^3 and Neutrophils 65% | 3500 x 0.65 —> 2275 cells/mm^3 (this person does not have Neturopenia |
| neutrophils are divided by mature and immature neutrophils (segs and bands are listed which are actually neutrophils)—> so add Segs + bands (61% + 2%) 63% and WBC count is 4.7 x 10^3/mm^3. What is the ANC? | 4700 x 0.63–>2961 cells/mm^3 |
| Neutropenia can occur because of _______. Who gets chemo? 1. ANC <1000? 2. ANC>/= 1500? | chemotherapy; 1. No chemo/ call MD (with chemo, it will drop even further) 2. Give Chemo |
| Myeloid Growth factor agents are? | a class of biological agents that regulate the proliferation, differentiation, survival, and activation of cells in the myeloid lineage; there are different kinds based on what cells they stimulate (G-CSF stimulate granulocytes; GM-CSF stimulate granuloyctes and macrophages) |
| Our Myeloid Growth factor agents that act on G-CSF are? | -Filgrastim (Neupogen) -Tpo-filgrastim (Granix) -Pegfilgrastim (Neulasta and Neulasta Onpro) -Eflapegrastim-xnst -Efbemalenograstim alfa-vuxw ($$$) |
| Our Myeloid Growth factor agents that act on on the GM-CSF is? | Sargramostim (Leukine) |
| Unique Frei Fact: These Myeloid Growth factor agents—> these drugs are recommended to be given ____-____ hrs after chemo | 24-72hrs; not given immediately after chemo (means pts have to come back to clinic the next day) *one of the devices can be given as a timed administration (about 27hrs after chemo or after its attached; can be taken at home, more comfortable but more $$$$ |
| ***What are the primary Adverse effects of MGF agents? | Flu-like symptoms; bone pain; joint pain; Recommendation: APAP, NSAIDS, Loratadine (Claritin) *histamine is a mediator of edema that happens in the bones from these drugs and that edema then causes pressure and pain in the bone, and so by blocking histamine, the theory is you ⬇️ the bone pain. |
| What are the Therapeutic uses of our MGF agents? | -Primary prophylaxis for febrile neutropenia (FN) (to prevent neutropenia) -Secondary prophylaxis for FN (prevent it from happening again) -Mobilization of peripheral blood stem cells (someone needs a transplant, peripheral stem cell, and over-production (aphoresis machine) -BMT failure or engraftment delay (bone marrow transplant, and given donor stem cells to make new immune system, but delay can occur and give MGF agents) -Special circumstances can be used for severe acute FN |
| Primary prophylaxis for using our MGF agents is for? | primary prevention of Febrile neutropenia (MGF given to prevent FN before it occurs) |
| What is the Risk assessment for FN (Febrile Neutropenia)? | 1. Chemotherapy regimen (disease state, pt risk factors, Tx intent (curative vs palliative) *some people are getting chemo to slow progression, because they’re metastatic already and won’t cure; some people are getting chemo for cure and so curative ones are more likely to try keep on chemo tx (more aggressive for cure) |
| ***For Primary prophylaxis of Febrile Neutropenia: For risk assessment, first evaluate Chemo regimen risk of Febrile Neutropenia—> **FN risk % will be given on the exam | 1. FN risk (high > 20%)—> give MGF 2. Intermediate (10-20%)—> consider other risk factors 3. Low (<10%)—> MGF not routinely given, can consider if >/= 2 risk factors present) |
| ***Primary Prophylaxis of Febrile Neutropenia: if the pt falls in the FN risk of intermediate (10-20%) recommendation is to consider MGF (if >/= 1 pt risk factors present— consider MGF). Risk factors TO REMEMBER are? | Age >65 years receiving full intensity chemo; persistent neutropenia; bone marrow involvement by tumor; prior to, including large areas of radiation; Presence of open wounds, recent surgery, or active infection; renal dysfunction (<50 ml/min); Liver dysfunction (total Bilirubin >2) |
| Pt case: if a pt has an FN risk of <10% and have 2 or more, do they get MGF tx? | yes |
| Secondary prophylaxis for FN is? | -MGF given to prevent febrile neutropenia or treatment delays after it has occurred – Did not receive primary prophylaxis with MGF -If previously given MGF for primary prophylaxis, consider dose reduction or change chemotherapy regimen |
| Example of Secondary prophylaxis case from Dr. Frei: | Pt on cycle 1 was hospitalized with Febrile neutropenia, they are here for cycle 2, should we give MGF? Yes -if they’ve gotten FN, the answer is yes—> that means they didnt get the MGF with cycle 1, so if they’ve got FN, and they already got it with cycle 1 and they still have FN, that’s another situation… |
| Special considerations for MGF are? | 1. We will not give growth factor at the same time your giving radiation therapy (believe that causes a more profound neutropenia) 2. Myeloid growth factors have to be administered b/w 24-96hrs after chemo (*ideally given day after chemo, exception—> Neulasta Onpro —> placed on day of chemo but delivers med 27hrs later 3. Pegfilgrastim or Eflapegrastim-xnst cannot be used if chemo every 1 week 4. Do not use w/in 14 days after chimeric antigen receptor (CAR) modified T cells |
| Pegfilgrastim or Eflapegrastim-xnst are _____ _______ agents and that means you cannot use them with weekly chemo because a lot of times, they are still in your system when you’re due for your next chemo, which would be toxic to your newly formed neutrophils | Long-acting |
| To mobilize stem cells, _____ is the most commonly used of our G-CSF Myeloid growth factor agents (given daily until collection of stem cells is complete) | Filgrastim; *pegfilgrastim given once 24hrs after chemotherapy) *will not use the G-CSF’s that start with “E” since they are newer and GM-CSF because it can stimulate other cells as well. |
| Stem cell mobilization: GM-CSF can be used in combination with G-CSF if pt ________ to collecting but not by itself | resistant |
| For post stem cells transplant to help with Engraftment we can use? | • MGF– Filgrastim/filgrastim sndz or Sargramostim • Started within a day of the infusion of stem cells • Continued until ANC > ~ 1,000 to 1,500 cells/mm3 for 3 consecutive days (also known as engraftment) *longer than 30 days can be considered delayed) |
| Filgrastim; Filgrastim-sndz; Filgrastim-aafi: Dose? Max dose? Freq? Indication | 5 mcg/kg/day (daily for Prophylaxis of FN; Tx of FN); 10 mcg/kg/day; max dose 32 mcg/kg/day (daily for stem cell mobilization) |
| TPO-filgrastim: Dose? Freq? Indication? | 5 mcg/kg/day (daily for prophylaxis of FN; Tx of FN) |
| Sargramostim: Dose? Freq? Indication? | 250 mcg/m^2/day (daily for post transplant, prophylaxis of FN in AML tx of FN) |
| Pegfilgrastim; Pegfilgrastim (-jmdb, -cbqv, -bmez: Dose? Freq? Indication? | 6 mg (once per cycle for prophylaxis of FN; Stem cell mobilization; cannot be used with weekly chemotherapy regimens) |
| Eflapegrastim-xnst: Dose? Freq? indication? | 13.2 mg (once per cycle for prophylaxis of FN) |
| Efbemalenograstim Alfa-vuwx: Dose? Freq? Indication? | 20 mg (once per cycle for prophylaxis of FN) |
| Conclusions: ________ can be a life-threatening condition as a result of chemotherapy | Neutropenia |
| Conclusions: MGF have several uses, including? | prevention of infection and mobilizing stem cells |
| G-CSF and GM-CSF can be used for the same indications; not enough data to support ________ of one product over the other | superiority |
Created by:
Xander635
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