neutropenia and non-GI toxicities

Question 1

ANC equation

Answer 1

((%neutrophils + %bands) x WBC) / 100

Question 2

Diagnosis of febrile neutropenia

Answer 2

• often asymptomatic besides fever
• CBC/CMP
• physical exam
• 2 blood cultures

Question 3

risk factors for neutropenia

Answer 3

• cancer type
• myelosuppressive chemo
• poor performance status
• malnourishment
• mucositis
• gut translocation

Question 4

cancer type risk of neutropenia from low to high

Answer 4

solid
lymphoma
autologous
leukemia
allogeneic

Question 5

most common pathogen involved in febrile neutropenia

Answer 5

pseudomonas

Question 6

MASCC score

Answer 6

risk calculator for neutropenia

• low is >=21
• high is <21

Question 7

oral antibiotics for low risk MASCC

Answer 7

• cipro + augmentin
• cipro/levo/moxi mono
• cipro/levo + clindamycin

Question 8

what don’t we give to patients with febrile neutropenia

Answer 8

tylenol so the fever isn’t hidden as it is the main indicator of infection

Question 9

empiric IV antibiotics for high risk MASCC

Answer 9

cefepime
pip/tazo
meropenem
ceftazidime

Question 10

indications for vancomycin in high risk MASCC

Answer 10

• hemodynamically unstable
• catheter
• severe sepsis
• potential MRSA
• pneumonia

Question 11

if decompensated fever after 2-4 days, what do we do

Answer 11

• consider adding another drug
• repeat CXR
• beta d glucan and galactomannan

Question 12

if decompensated fever after 4-7 days, what do we do

Answer 12

-add antifungal

Question 13

how long to treat febrile neutropenia with antibiotics

Answer 13

• when afebrile for 48 hours and ANC > 500

- resolution of infection

Question 14

growth factor prophylaxis drugs for febrile neutropenia

Answer 14

pegfilgrastim or filgrastim

Question 15

tyrosine kinase inhibitor unique adverse effects

Answer 15

• acneiform
• hard-foot syndrome
• elevated blood pressure
• endocrine

Question 16

acneiform rash prophylaxis

Answer 16

all EGFR inhibitors

• sunscreen
• hydrocortisone BID
• doxy/mino

Question 17

acneiform rash presentation

Answer 17

within 7-10 days of exposure of EGFR inhibitors

Question 18

hand foot syndrome presentation

Answer 18

redness, swelling, blistering/peeling on palms and soles of feet

Question 19

common causes of hand foot syndrome

Answer 19

VEGF antagonists
sunitinib
bevacizumab

Question 20

treatment for hand foot syndrome

Answer 20

• lukewarm showers
• avoid friction
• wear well-fitted shoes
• moisturizers
• lidocaine
• clobetasol

Question 21

common toxicities of immune therapy

Answer 21

dermatitis
colitis
thyroiditis
hepatitis
pneumonitis

Question 22

treatment for immune therapy toxicities

Answer 22

• corticosteroids

- infliximab for colitis

Question 23

manifestations of cardiotoxicity

Answer 23

• arrhythmias
• edema
• heart failure
• hypertension
• left ventricular dysfunction
• qt prolongation
• thromboembolism

Question 24

risk factors for cardiotoxicity

Answer 24

• prior chemotherapy
• radiation therapy
• concurrent meds

Question 25

type I cardiotoxicity features

Answer 25

• permanent
• cumulative
• dose related
• caused by doxorubicin

Question 26

type II cardiotoxicity features

Answer 26

• reversible
• not cumulative
• not dose related
• caused by HER2

Question 27

treatment strategy of neuropathy toxicity

Answer 27

*mainly peripheral
gabapentin
pregabalin
vitamin B6

Question 28

drug that causes pulmonary fibrosis

Answer 28

bleomycin

Question 29

management of bleomycin associated pulmonary fibrosis

Answer 29

• lifetime cumulative dose of 450 units

- baseline pulmonary function test