Exam 2 - Oncologic Emergencies Part 2 Flashcards
What is treatment for intermediate risk tumor lysis syndrome patients? (3)
hydration, allopurinol, and if hyperuricemic rasburicase
What is treatment for high risk tumor lysis syndrome patients? (3)
hydration, rasburicase, and allopurinol AFTER rasburicase
What is the MOA of allopurinol?
blocks the conversion of hypoxanthine to xanthine and xanthine to uric acid
What is the MOA of rasburicase?
replacement enzyme that acts as urate oxidase to allow for uric acid conversion to allantoin
What is the dosing for allopurinol in tumor lysis syndrome?
300 mg/m^2/day or 10 mg/kg/day PO in 3 divided doses q8 hrs
What are the AEs of allopurinol?
generally well tolerated, SJS/TEN
Which medication can be used in renal impairment when treating tumor lysis syndrome?
allopurinol
What is the dosing for rasburicase?
1.5-3 mg IV, may repeat if uric acid remains 7.5+ mg/dL
What are the AEs of rasburicase?
peripheral edema, skin rash, abdominal pain, constipation/diarrhea, hemolysis in G6PD deficiency
What is a clinical pearl for rasburicase?
obtain a rasburicase uric acid; ice water bath to prevent rasburicase from continuing to degrade uric acid
What are treatments for hyperkalemia as a result of tumor lysis syndrome? (6)
loop diuretics, calcium chloride/gluconate 1 g IV over 2-3 minutes, insulin 10U IV bolus, sodium bicarbonate 50 mEq IV, sodium polystyrene 15-60 g PO, hemodialysis or CRRT
What are treatments for hyperphosphatemia as a result of tumor lysis syndrome? (5)
calcium acetate, calcium carbonate, aluminum hydroxide, lanthanum, sevelamer
What is treatment for hypocalcemia as a result of tumor lysis syndrome?
do NOT treat unless symptomatic (calcium gluconate)
Describe the incidence of febrile neutropenia?
typically occurs one week after chemo, risk factors include age 65+/gender/low BMI/previous chemo/comorbidities
Define febrile neutropenia?
absolute neutrophil count <500 cells/µL OR <1000 and expected to drop to <500 in 48 hrs
Define fever?
single temperature >38.3°C (100.9°F) OR temperature >38°C (100.4°F) for over 1 hr
Who is considered low infection risk with regards to prophylaxis?
standard chemo for solid tumors, anticipated neutropenia <7 days
Who is considered intermediate infection risk with regards to prophylaxis?
those with autologous transplants, non-solid tumors, purine analog therapy (e.g., fludarabine), anticipated neutropenia 7-10 days, CAR T-cell therapy
Who is considered high infection risk with regards to prophylaxis?
allogeneic transplants, severe non-solid tumors, anticipated neutropenia >10 days
Explain low infection risk with regards to prophylactic recommendations?
all none except viral if Hx HSV infection
Explain intermediate infection risk with regards to prophylactic recommendations?
all consider during neutropenia and for viral possibly longer
Explain high infection risk with regards to prophylactic recommendations?
for fungal and PJP consider during neutropenia, for bacterial during neutropenia and for viral possibly longer
What are the bacterial prophylactic antimicrobials used for febrile neutropenia? (3)
levo/ciprofloxacin, cefpodoxime, penicillin VK (all PO)
What are the fungal prophylactic medications used for febrile neutropenia? (3)
flu/posa/vori/itra/isavuconazole (PO), micafungin (IV), liposomal amphoterecin B
What is the viral prophylactic medication used for febrile neutropenia?
acyclovir (PO)
What is the antimicrobial used to cover PJP in febrile neutropenia?
sulfamethoxazole-trimethoprim (PO)
What MASCC score is considered low risk? High risk?
low = <21, high = 21+
What are treatments for low risk MASCC scores?
ciprofloxacin plus Augmentin (both PO bid), levo/moxifloxacin (PO qd)
What are treatments for high risk MASCC scores?
cefepime, Zosyn, meropenem (all IV qid-tid)
When should MRSA coverage be considered? (5)
patients with catheter-related infections, pneumonia, mucositis, SSTIs, hemodynamic insufficiency or sepsis
What are treatments for MRSA coverage? (3)
vancomycin, linezolid, daptomycin
What is the duration of therapy for unknown origin of infection in febrile neutropenia? (2)
neutrophils 500+ cells/µL = dscontinue, neutrophils <500 cells/µL = discontinue therapy/de-escalate to prophylaxis/continue regimen until neutropenia resolves
What is the duration of therapy for documented SSTI in febrile neutropenia?
5-14 days
What is the duration of therapy for Gram positive/negative bacteremia in febrile neutropenia?
7-14 day UNLESS S. aureus (4 weeks)
What is the duration of therapy for bacterial sinusitis in febrile neutropenia?
7-14 days
What is the duration of therapy for bacterial pneumonia in febrile neutropenia?
5-14 days
What is the duration of therapy for a Candida infection in febrile neutropenia?
minimum 2 weeks
What is the duration of therapy for a mold infection in febrile neutropenia?
minimum 12 weeks
What is the duration of therapy for HSV/VZV in febrile neutropenia?
7-10 days
What is the duration of therapy for influenza in febrile neutropenia?
minimum 5 days
