15 Management of Side Effects Flashcards
What is the lifespan of circulating RBCs?
100-120 days
What is the lifespan of WBCs?
13-20 days
What is the lifespan of platelets?
8-10 days
When is the nadir for lomustine?
35-45 days
What is the most common dose limiting toxicity?
bone marrow suppression
You can only give neulasta if there are how many days until next chemo?
14 at least
What is a good platelet cutoff for surgery?
75-100
What is a cutoff for SCD patients getting a transfusion?
6 or less, (10 if chronic transfusion protocol)
What is the hgb transfusion parameter for a patient undergoing XRT?
- oxygenated cells do better
If hgb is less than 5, what is the appropriate transfusion rate?
5 ml/kg/dose over a 4 hour period. careful monitoring for fluid overload and cardiac failure.
What does erythropoietin do?
a growth factor that promotes proliferation of erythrocytes. given subQ
What are 3 internal flora that are often the cause of infection in a neutropenic child?
staph, e coli and candida. they can get these regardless of protective measures
Fever in a patient with an implanted device is always significant. Name 3 implanted devices
CVAD, VP shunt, and artificial joint
Most frequent source of CVAD infections?
gram pos bacteria, like staph.
What is needed after 5-7 days fever/neutropenia?
fungal workup, usually with CT scan and antifungal coverage is started
What does an AML patient/post transplant patient or someone with MRSA/skin infections need right away when febrile?
gram positive coverage/vanc
Gut integrity is impaired due to bacterial infection - what coverage/ drugs are needed?
anaerobic - clindamycin or metronidazole
What do you monitor with amphotericin when treating fungal infection
electrolytes - hypokalemia, severe reactions
Treatment for varicella?
acyclovir/ganciclovir
Possible SE of dapsone? (for PCP prophy)
methemoglobinemia - esp with G6PD
Pt has painless ulcers, redness in mouth, mild soreness but no lesions. Which grade mucositis?
I.
Mucositis is painful with redness, edema and ulcers, but pt can still eat/swallow. What grade?
II
Mucositis is painful with ulcers requiring IV hydration, what grade?
III
severe ulceration, TPN dependent mucositis is what grade?
IV
How does oral care/rinses help mucositis?
Good dental and oral care may not prevent mucositis, but they have a major effect on severity of mucositis by decreasing the potential for secondary infections.
What is an example of an NK1 receptor antagonist antiemetic?
Emend. usually used in combo with dex and zofran
What drug class are promethazine and compazine? and reglan (metoclopramide)
dopamine antagonists, usually used for breakthrough N/V
Large doses of ginger can inhibit what?
platelet production
A patient taking steroids, TPN or asparaginase presents with nausea and right sided abd pain, what could it be?
pancreatitis. send amylase/lipase
What do you do to treat pancreatitis?
NPO for gut rest, Opiods for pain management, when able to refeed do low fat diet. Can use pancreative enzymes to help.
Even though TPN can cause it, it must be used during gut rest.
Elevated transam/bili, coag issues, weight gain/edema, flu like symptoms and R side abdominal pain can be
Hepatitis (chemical or viral)
Treatment for hepatitis?
fluid and electrolyte replacement, antipruritics, pain mgmt. steroids may decrease inflammation.
What kind of diet for hepatitis?
low fat/high glucose
What GI symptom can be caused by XRT to abd/pelv/lower spine
diarrhea
What in neuroblastoma patients can cause diarrhea?
catecholamine release
What are 2 meds to treat c diff
oral vanc, metronidazole
What level of XRT is associated with permanent hair loss?
greater than 4000 cGy
