Neutropenia

Question 1

Per IDSA 2011 guidelines neutropenia is ANC < __ cells/mm3

Answer 1

500

Question 2

With cancer, the type of __ dictates expected neutropenia

Answer 2

chemotherapy

Question 3

What physiological response do neutropenic pts have to infection?

Answer 3

fever

Question 4

Fever is a single oral temp >= __C

Answer 4

38.3

101F

Question 5

Fever is a temp of >= __C for >=1 hour

Answer 5

38

100.4

Question 6

Common gram positive in neutropenia?

Answer 6

Staph aureus

Question 7

2 common gram negatives in neutropenia?

Answer 7

Pseudomonas

enterobacteriaceae

Question 8

Failure to provide anti___ therapy within 48 hours of onset of fever in neutropenic cancer pts has led to mortality rates as high as __ %

Answer 8

pseudomonal, 70

empiric therapy is 70-90% effective at reducing early morbidity and mortality

Question 9

Common sources of infection?

Answer 9

IV lines (Port, PICC)
mucositis

Question 10

2 main alterations of patient’s microbiota that are risk factors?

Answer 10

antibiotics

acid suppression

Question 11

Duration > ___ days is high risk for febrile neutropenia

Answer 11

7-10

Question 12

What drug is high risk for febrile neutropenia?

Answer 12

alemtuzumab

Question 13

___ HCT is high risk for febrile neutropenia

a. autologous
b. allogeneic

Answer 13

b. allogeneic

Question 14

Fluoroquinolones have a FDA alert for hypo/hyperglycemia

a. true
b. false

Answer 14

a. true

Question 15

2 main FDA alerts for fluoroquinolones?

Answer 15

hypo/hyperglycemia

aortic dissection or ruptures

Question 16

What antibiotic class is given for intermediate and high risk neutropenic fever prophylaxis?

Answer 16

fluoroquinolones

Question 17

Fluoroquinolones can cause C.diff

a. true
b. false

Answer 17

a. true

Question 18

IV antibiotics is necessary for inpatient treatment

a. true
b. false

Answer 18

a. true

monotherapy preferred:

• cefepime
• ceftazidime
• carbapenem
• pip-taz

Question 19

What is goal trough for vanc in empiric neutropenic fever Tx?

Answer 19

10-15

Question 20

When can vanc be used as initial empiric therapy?

Answer 20

sepsis
pneumonia
gram positive organism isolated
suspected CLABSI
MRSA 
severe mucositis

Question 21

What is drug of choice for neutropenic fever Tx?

Answer 21

cefepime

Question 22

When should antifungal coverage be added?

Answer 22

if persistent fever after 4-7 days of broad spectrum therapy

Question 23

What drug is added for antifungal therapy?

Answer 23

echinocandin

Question 24

Invasive fungal infections are more common with profound neutropenia for > __ to __ days

Answer 24

5, 10

profound neutropenia is ANC < 100

Question 25

Do not use itraconazole for neutropenic fever

a. true
b. false

Answer 25

a. true

does not have appropriate coverage; use tori or post/isavu

Question 26

Gram positive empiric coverage can be d/c after __ days if no evidence of gram positive infection

Answer 26

2

Question 27

G-CSF is not generally recommended for febrile neutropenia

a. true
b. false

Answer 27

a. true

Question 28

____ organisms are the most common cause of neutropenic fever

a. gram positive
b. gram negative

Answer 28

a. gram positive

Question 29

___ organisms cause mortality the quickest

a. gram positive
b. gram negative

Answer 29

b. gram negative