neutropenia and non-GI toxicities Flashcards
ANC equation
((%neutrophils + %bands) x WBC) / 100
Diagnosis of febrile neutropenia
- often asymptomatic besides fever
- CBC/CMP
- physical exam
- 2 blood cultures
risk factors for neutropenia
- cancer type
- myelosuppressive chemo
- poor performance status
- malnourishment
- mucositis
- gut translocation
cancer type risk of neutropenia from low to high
solid lymphoma autologous leukemia allogeneic
most common pathogen involved in febrile neutropenia
pseudomonas
MASCC score
risk calculator for neutropenia
- low is >=21
- high is <21
oral antibiotics for low risk MASCC
- cipro + augmentin
- cipro/levo/moxi mono
- cipro/levo + clindamycin
what don’t we give to patients with febrile neutropenia
tylenol so the fever isn’t hidden as it is the main indicator of infection
empiric IV antibiotics for high risk MASCC
cefepime
pip/tazo
meropenem
ceftazidime
indications for vancomycin in high risk MASCC
- hemodynamically unstable
- catheter
- severe sepsis
- potential MRSA
- pneumonia
if decompensated fever after 2-4 days, what do we do
- consider adding another drug
- repeat CXR
- beta d glucan and galactomannan
if decompensated fever after 4-7 days, what do we do
-add antifungal
how long to treat febrile neutropenia with antibiotics
- when afebrile for 48 hours and ANC > 500
- resolution of infection
growth factor prophylaxis drugs for febrile neutropenia
pegfilgrastim or filgrastim
tyrosine kinase inhibitor unique adverse effects
- acneiform
- hard-foot syndrome
- elevated blood pressure
- endocrine
acneiform rash prophylaxis
all EGFR inhibitors
- sunscreen
- hydrocortisone BID
- doxy/mino
acneiform rash presentation
within 7-10 days of exposure of EGFR inhibitors
hand foot syndrome presentation
redness, swelling, blistering/peeling on palms and soles of feet
common causes of hand foot syndrome
VEGF antagonists
sunitinib
bevacizumab
treatment for hand foot syndrome
- lukewarm showers
- avoid friction
- wear well-fitted shoes
- moisturizers
- lidocaine
- clobetasol
common toxicities of immune therapy
dermatitis colitis thyroiditis hepatitis pneumonitis
treatment for immune therapy toxicities
- corticosteroids
- infliximab for colitis
manifestations of cardiotoxicity
- arrhythmias
- edema
- heart failure
- hypertension
- left ventricular dysfunction
- qt prolongation
- thromboembolism
risk factors for cardiotoxicity
- prior chemotherapy
- radiation therapy
- concurrent meds
type I cardiotoxicity features
- permanent
- cumulative
- dose related
- caused by doxorubicin
type II cardiotoxicity features
- reversible
- not cumulative
- not dose related
- caused by HER2
treatment strategy of neuropathy toxicity
*mainly peripheral
gabapentin
pregabalin
vitamin B6
drug that causes pulmonary fibrosis
bleomycin
management of bleomycin associated pulmonary fibrosis
- lifetime cumulative dose of 450 units
- baseline pulmonary function test
