Final Exam Random Things to Know Flashcards
MIVF fluids per day range
30-40 mL/kg/day
protein per day range if NOT in ICU
1-1.5 g/kg/day
protein per day range if pt is in the ICU/surgery
1.5-2 g/kg/day
one gram protein = ___ kcal
4
kcal per day range for surgery/ICU pt
25-30 kcal/kg/day
IBW male equation
50 kg + (2.3 * inches over 60”)
IBW female equation
45.5 kg + (2.3 * inches over 60”)
nutritional body weight formula
NBW = IBW + 0.25(wt - IBW)
CRP is used to assess accuracy of ________
prealbumin
prealbumin decreases as CRP increases -> _______
a. inflammation
b. malnutrition
a. inflammation
prealbumin decreases as CRP normal -> _______
a. inflammation
b. malnutrition
b. malnutrition
nitrogen balance formula
(N in) - (N out)
N in = 24-hr protein intake/6.25
N out = UUN + 4
REE = 1950; RQ 0.74
calculate TEE
1950 * 1.2 = 2340 kcal/day
standard distribution on non-protein calories
70/30 (70% carbs, 30% fat)
3 central venous catheter insertion sites
subclavian (SC)
internal jugular (IJ)
femoral
one gram dextrose = ____ kcal
3.4
one gram lipids = ____ kcal
~10
SMOF lipid components
-soybean oil 30%
-medium-chained TGs 30%
-olive oil 25%
-fish oil 15% (allergies)
intralipid 10% components
soybean oil 10%
glycerin 2.25% (allergies)
egg yolk phospholipid 1.2% (allergies)
water for injection
which is avoided if you have an egg allergy?
a. intralipid
b. SMOFlipid
a. intralipid
which should be avoided with a fish allergy?
a. intralipid
b. SMOFlipid
b. SMOFlipid
___ micron filter can be used for all total nutrient admixtures (TNAs) or 3-in-1 (w/lipids)
a. 0.22
b. 1.2
c. 2.0
b. 1.2
___ micron filter is only used for 2-in-1 formulations (no lipids)
a. 0.22
b. 1.2
c. 2.0
a. 0.22
CrCl < 50
a. Clinimix no electrolytes
b. Clinimix with electrolytes
a. Clinimix no electrolytes
CrCl > 50
a. Clinimix no electrolytes
b. Clinimix with electrolytes
b. Clinimix with electrolytes
trace element adjustments in liver dysfunction (2 things)
-d/c trace elements
-supplement individually zinc 5 mg (1 mL), selenium 60 mcg (1 mL)
Which of the following is TRUE about trace element adjustments in renal disease?
a. consider checking serum levels if use expected beyond 7 days
b. use selenium and chromium with caution
c. same rules apply for CRRT
b. use selenium and chromium with caution
T or F: iron is recommended to be added to PNs
F
TPN calcium and magnesium starting levels if normal
Ca 10 mEq/day
Mg 8 mEq/day
3 main electrolyte issues in refeeding syndrome
hypophosphatemia
hypomagnesemia
hypokalemia
prevention of refeeding syndrome:
-limit carbs to ___-___ gm
-limit fluids to ___ mL/day
-provide adequate amounts of ________
-provide approx ___% of total caloric needs
100-150
800
electrolytes
50%
PEG location of the distal end of feeding tube
stomach
PEJ location of distal end of feeding tube
small intestine (jejunum)
T or F: it is ok to crush sustained-release or enteric coated formulations via enteral feeding tubes
F (can crush other tablets tho)
Hodgkin’s Lymphoma is characterized by which cells?
Reed-Sternberg cells
what are the 3 B symptoms?
fever > 38 C
drenching night sweats
weight loss greater than 10% in 6 months
which of the following describes Hodgkin Lymphoma?
a. more frequent involvement of multiple peripheral nodes
b. noncontiguous spread
c. waldeyer ring and mesenteric nodes rarely involved
d. extranodal presentation common
c. waldeyer ring and mesenteric nodes rarely involved
Hodgkin’s lymphoma 2 chemo regimens
ABVD
AAVD
which one drug is different between the ABVD and AAVD regimen for HL?
ABVD has bleomycin, AAVD has brentuximab vedotin
maintenance tx for relapsed HL
brentuximab vedotin
tx for relapsed HL
high dose chemo with autologous stem cell transplant
T or F: follicular lymphoma can transform into an aggressive NHL (non-Hodgkin lymphoma)
T
NHL chemo regimen
R-CHOP
what drugs are in R-CHOP?
-rituximab
-cyclophosphamide
-doxorubicin
-vincristine
-prednisone
which virus can be reactivated in pts with NHL and rituximab?
Hep B
two third line BiTEs for NHL
epcoritamab
glofitamab
BiTEs 2 unique toxicities
-cytokine release syndrome (CRS)
-immune effector cell-associated neurotoxicity syndrome (ICANS)
Multiple Myeloma CRAB criteria
-hypercalcemia (Ca > 11.5)
-renal dysfunction (SCr > 2 or CrCl < 40)
-anemia (Hgb < 10 or 2 below normal)
-bone lesions (one or more lesions or fractures)
which drug class is indicated for all pts receiving primary myeloma therapy?
bisphosphonates
multiple myeloma: there is an inc risk of infection with what 2 drug classes?
proteasome inhibitor
monoclonal antibodies
cornerstone of Multiple Myeloma therapy
autologous stem cell rescue
first line drug class for tx of CML
TKI inhibitors (imatinib)
3 2nd gen TKIs
dasatinib
nilotinib
bosutinib
for TKI discontinuation, which value is a deep molecular response?
a. BCR-ABL < 0.01
b. BCR-ABL < 0.05
c. BCR-ABL < 0.10
d. BCR-ABL < 0.5
a. BCR-ABL < 0.01
CLL: transient lymphocytosis may occur with which inhibitors?
BTK inhibitors
first line tx for CLL
BTK inhibitor +/- venetoclax
which drug is NOT used 2nd line for FLT3 mutations in pts with AML?
a. imatinib
b. midostaurin
c. quizartinib
d. gilteritinib
a. imatinib
the 7+3 intensive chemo regimen is for which disease state?
a. CML
b. CLL
c. AML
d. ALL
c. AML
what is the 7+3 regimen for AML?
7 days cytarabine, 3 days of anthracycline
important mutation for AML
t(15;17) = PML:RARA
two drugs to treat APL
ATRA (all trans retinoic acid)
ATO (arsenic trioxide)
SE of all trans retinoic acid (ATRA)
a. QT prolongation
b. diarrhea
c. differentiation syndrome
d. neurotoxicity
c. differentiation syndrome
SE of arsenic trioxide (ATO)
a. QT prolongation
b. diarrhea
c. differentiation syndrome
d. neurotoxicity
a. QT prolongation
main chemo regimen for ALL
a. CRAB
b. HyperCVAD
c. R-CHOP
d. AAVD
b. HyperCVAD
what is the importance of pegaspargase in ALL?
pegaspargase breaks down asparagine, which cancer cells cannot make their own, so will undergo cellular death
for ALL, if a pt is Philadelphia Chromosome positive, what drug class can we add?
tyrosine kinase inhibitor
