Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
EXAM 3 ONC FREI
| FRONT | BACK | NOTES |
|---|---|---|
| ANC formula | WBC x % neutrophils (segs + bands) | |
| Chemop based on ANC | ANC < 1000 NO CHEMO ANC 1500 or more give chemo | |
| Primary ADRs of MGFs (G-CSF and GM-CSFs) | Flue-like symptoms, bone pain, joint pain | Give APAP, NSAIDs, loratadine (histamine mediated bone swelling) |
| Why MGFs | Primary FN - febrile neutropenia prophylaxis, stem cell mobilization, BMT failure, acute FN | Given to prevent FN before it occurs |
| Patient FN risk factors (consider for intermediate and low) | 65 or older on full chemo, persistent neutropenia, bone marrow involvement, large areas of radiation or prior treatment, infection, open wounds, recent surgery, CrCl < 50, bilirubin >2 | |
| FN Risk - Primary prophylaxis | High > 20% - give MGF Intermediate 10-20% - consider risk factors (1 or more consider MGF) Low <10% - consider MGF if 2 or more risk factors | |
| MGF admin rules | Do not use with radiation, Wait at least 24 hours after chemo to admin (24-96) (give neulasta onpro the same day), Cannot use pegfilgastrim or eflapegrastim-xnst if getting weekly chemo, Do not use within 14 days after CAR mod t-cells | |
| Stem cell mobilization | Give GCSF filgrastim daily intil collection complete OR give pegfilgrastim 24 hours after chemo If collection resistant give GMCSF | Peg-grastim or pegfilgastrim are given only once per cycle instead of daily like normal filgratim |
| Secondary Prophylaxis for FN | MGF given to prevent FN or delays casued by it | if previously given MGF for primary prophylaxis, lower dose or change chemo regimen |
| Neutropenia | ANC < 1500 cells/mm3 | |
| Febrile neutropenia | ANC < 500/mm3 or <1000 and falling + oral temp > 38.0 (100.5) for over an hour or > 38.3 (101) a single time | |
| FN Management | Triage - within 15 minutes Antimicrobials - within 1 hour Placement - after 4 hours of observation | |
| Triage of Patient | Site specific history and physical, CBC, test electrolytes, liver/renal function (gen. workup) 2 sets of blood cultures from each lumen of existing central line and a peripheral line site if present 2 blood cultures And site specific cultures | Antibiotics should be given within one hour of triage (PsA therapy - cefepime, imipenem-cil, meropenem, pip-tazo |
| Placement within 4 hours based on MASCC and CISNE | MASCC score under 21 - inpatient MASCC score 21 or over - refer to CISNE CISNE score 1 or 2 - outpatient CISNE score 3 or more - inpatient | Max MASCC score of 26 CISNE 3 or more is inpatient |
| Treatment of Outpatient FN(Low Risk) PO therapy | Cipro + Amox/clav (if PCN allergic use clindamycin) OR Moxifloxacin | |
| Treatment of High Risk FN | Anti-pseudomonal B-lactam Cefepime (maxipime), imipenem/cilastatin, merropenem, pip/tazo (zosyn) | switch IV to PO if GI can tolerate |
| Antimicrobial additions | MRSA, Skin/Soft Tissue Infection, catheter-related infection, pneumonia, hemodynamic instability, c. diff - add vancomycin VRE: linezolid or dapto ESBLs: carbapenem | |
| Duration of antibiotics | Afebrile for 48 horus + ANC > 500/mm3 - may consider stopping Afebrile but ANC < 500/mm3 - stop after 5-7 days Febrile - Reassess causes, ANC does not matter | If cause is known narrow therapy and treat specifically |
| Persistent fever | No change -continue antibiotics, consider stopping additions Cancer progression IF inadequate response after 5 days with antibacterial coverage, add anti-fungal and consider therapy change | |
| Antifungal therapy | Candida can appear after 1 week Aspergillus may appear after 2-3 weeks Only given after 5 days of inadequate response to antimicrobials | Risk factors: Hematological malignancies, cytotoxic chemotherapy, agents that cause mucosal injury, prolonged neutropenia, broad spectrum antibiotics |
| When to use MGF in Neutropenia | Only continue or give MGF if pts developed FN while already on MGF | MGF can be used if pt has any 1 of the following: sepsis syndrome, age >65 yo, ANC < 100, duration of neutropenia expected to be >10 days, pneumonia or infection, invasive fungal infection, hospitalization at time of fever, or prior episode of FN |
| Thrombocytopenia | Platelet count < 150/mm3 or relative thrombocytopenia (50% decrease in plt) | |
| Meds that can cause Thrombocytopenia | Quinine/quinidine Sulfonamide antibiotics Vancomycin Penicillin Carbamazepine Rifampin Heparin Abciximab (GPIIb/IIIa inhibitors) NSAIDs H2 antagonists Chemotherapy Valproic acid | |
| Treatment for medication induced thrombocytopenia (most common cause) | stop offending medication, monitor, CBC daily or more, transfuse plts if < 10,000 | |
| Immune trombocytopenia purpura (ITP) | PLt < 100k and cause unknown, normal RBC and WBC | new - under 3 months persistent - 3-12 months chronic - longer than 12 months |
| ITP management | 1st line ITP Prednisone, dexamethasone, IVIG transfusion under 10k plt | Active bleeding: steroids and IVIG, transfusion, consider splenectomy |
| Refractory ITP | Rituximab QW for 4 weeks, repeat if necessary | Hep-B reactivation test for hep b |
| Chemo induced thrombocytopenia (CIT) | PLt < 100K no chemo, over 150k give chemo | Treatment: transfusion if plt < 10 K Chemo dose reduction or delay ROMIPLOSTIM - only TPO used in CIT |
| Breast cancer prevention based on 5-year IBC risk | Low risk: <3% no intervention High risk 35 or over and over 10 year life expectancy - splint into post menopausal and pre/perimenopausal | pre/perimenopausal - tamoxifen postmenopausal - raloxifene (prevention only) , tamoxifen (2D6) (raloxifene and tamoxifen can cause endometrial hyperplasia, VTE and cataracts), aromatase inhibitors (can cause arthralgia/myalgias/fatigue |
| Types of breast cancer | HR+ (ER/PR +) most common best prognosis Her2+ - worse prognosis but predicts response to Her2 treatment Her2 low Triple negative (ER/PR/HER2 negative) | |
| Breast cancer characteristics to consider | HR/PR status, HER@ status, size of cancer, # of lymph nodes with cancer, metastatic status (incurable) | take everyones titties off |
| Treatments for curable (stage 1-3) breast cancer | Surgery mastectomy (full titty) or lumpectomy (mass) + breast tissue rad Radiation - if given lumpectomy give breast rad, if lymph node + give axillary rad HR+ = endocrine therapy HER2+ = trastuzumab therapy TNBC = chemo +/- pembrolizumab | rad usually after chemo, not given at the same time as hormone therapy |
| Adjuvant/neoadjuvant therapies for aggressive breast cancer | Chemotherapy, ET, Trastuzumab/Pertuzumab, PARPi, CDKi 4/6, Chemotherapy, T-DM1, PARPi, CDKi 4/6, Immunotherapy, Others | |
| Management of triple negative breast cancer | LN + chemotherapy (AC-doxorubicin/cyclophosphamide OR TC-docetaxel/cyclophosphamide) and olaparib if BCRAm+ + pre/post operative pembrolizumab LN - further broken down based on tumor size | 0.5cm or lower, no therapy 0.6-1 cm - chemotherapy and olaparib if BCRAm+ over 1 cm - chemotherapy and olaparib if BCRAm+ |
| irAEs (ADRs from pembrolizumab) | skin, GI, endocrine If experience symptoms start steroids and stop immunotherapy | |
| Management of HER+ and HR+ EBC | LN + chemo with trastuzumab + pertuzumab and ET | LN - less than 0.5 cm consider ET OR consider ET + chemo + trastuzumab 0.6-1cm - ET OR ET + chemo + trastuzumab over 1 cm ET + chemo + trastuzumab +/- pertuzumab (for T2/T3) |
| HER2+ but HR - (NO endocrine therapy ET because HR negative) | LN + chemo with trastuzumab + pertuzumab | LN - less than 0.5 cm consider chemo + trastuzumab 0.6-1cm - chemo + trastuzumab over chemo + trastuzumab +/- pertuzumab (T2/T3) |
| HER2+ | 1 year of trastuzumab or 14 cycles or ado/fam +/- pertuzumab + taxane | do not take either with anthracyclines |
| HR+ and HER2 - | LN + 4 or over - Chemo, then ET +/- ovarian ablation, consider CDK4/6i LN + less than 4 r tumor > 0.5 cm - consider gene expression assay Tumor less than 0.5 cm and LN- - consider adjuvant ET | only difference in pre menopause and postmenopause treatment is there is NO ovarian ablation i postmenopausal |
| 21-gene expression assay result interpretation | 26 or over is pre/post menopause are given chemo, below 26 no chemo | |
| ADRs of treatments | Doxorubicin - cardiomyopathy cyclophosphamide - hemorrhagic cystitis Paclitaxel - neuropathy Carboplatin - myelosuppression Pembrolizumab - immune mediated toxicites | |
| Hormonal therapy | Post - aromatase inhibitors Pre - tamoxifen or tamoxifen + ovarian suppression or aromatase inhibitor + ovarian suppression | minimum use of 5 years but can do up to 10 years |
Created by:
beezy41