onco emergencies

Question 1

what are the risk factors for febrile neutropenia

Answer 1

age 65 or older
pre existing neutropenia
gender
low bmi or bsa
previous chemo or radiation
poor performance status
comorbidities(renal, hepatic, cardiac dysfunction), HIV, active infection, surgery
specific genetic polymorphisms

Question 2

defintion of neutropenia

Answer 2

ANC<500 or ANC<1000 and expected to drop BELOW 500 in 48 hours

Question 3

definition of fever

Answer 3

single temp > 38.3 degrees Celsius or temp over 38 degrees Celsius for over one hour

Question 4

gram + bacteria that may cause febrile neutropenia

Answer 4

coagulase - staphylococci
**s.aureus
enterococcus
streptococci

**s aureus has a distinct duration of therapy for all the other pathogens

Question 5

gram - bacteria that may cause febrile neutropenia

Answer 5

e.coli
k.pneumoniae
enterobacter
p.aeruginosa

Question 6

viruses that may cause febrile neutropenia

Answer 6

herpes simplex
varicella zoster
RSV
Cytomegalovirus
influenza

Question 6

fungi that may cause febrile neutropenia

Answer 6

candida and aspergillus

Question 7

low infection risk for febrile neutropenia

Answer 7

standard chemo regimens for most solid tumors
anticitpated neutropenia less than 7 days

Question 8

intermediate infection risk for febrile neutropenia

Answer 8

-autologous hematopoietic cell transplant
-lymphoma
-multiple myeloma
-chronic lymphocytic leukemia
-purine analog therapy
-anticipated neutropenia for 7-10 days
-CAR T cell therapy

Question 9

high infection risk for febrile neutropenia

Answer 9

ALLOGENIC hematopoietic cell transplant
acute leukemia
alemtuzumab therapy
mod-severe graft vs host disease
anticipated neutropenia for OVER 10 days

Question 10

when is the only time you can consider antimicrobials for low infection risk prohylaxis

Answer 10

when the cause is viral, and the patient was previously infected with herpes simplex

Question 11

bacterial ppx

Answer 11

levofloxacin 500mg PO daily
cefpodoxime 200mg PO daily
ciprofloxacin 500 mg PO BID
Penicillin VK 500 mg PO BID

Question 12

fungal ppx

Answer 12

fluconazole 400 mg PO daily
Posaconazole 300 mg PO daily
Voriconazole
isavuconazole 372 mg PO daily
micafungin 100 mg IV daily

Question 13

viral ppx

Answer 13

acyclovir 400 mg PO BID

Question 14

PJP ppx

Answer 14

bactrim 800/160 mg PO mon weds fri
OR 800/160 mg PO BID on saturday and sunday

Question 15

main therapies for MRSA treatment

Answer 15

vanco
linezolid
daptomycin

Question 16

what illnesses prompt MRSA coverage

Answer 16

catheter related infections
pneumonia
mucositis
SSTI
hemodynamic insufficency or sepsis

Question 17

when should you consider fungal covergae in patients post ppx therapy?

if the patient is eligible when should you initate therpay and what markers should be collected

Answer 17

high risk patients who have hematologic malignancies
patients who become hemodynamically unstable and/or develop signs of sepsis

**add at the 4-7 day mark and the markers you can collect are 1,3 beta d glucan and galactomannan

Question 18

main therpaies for fungal treatment

Answer 18

fluconazole
isavuocnazole
posaconazole
liposomal amp B
voriconazole
itraconazole
micafungin

Question 19

duration of therapy for unknown origin of infection and neutrophils are 500+

Answer 19

discontinue therapy!!!

Question 20

duration of therapy for unknown origin of infection and neutrophils are <500

Answer 20

d/c therpay
de escalate to ppx!!
continue regimen until neutropenia resolves ???

Question 21

duration of therapy for SSTI

Answer 21

5-14 days

Question 22

duration of therapy for bacterial sinusitis

Question 22

duration of therapy for gram + or - bacteremia

Answer 22

7-14 days

Question 23

duration of therapy for bacterial pneumonia

Answer 23

5-14 days

Question 24

duration of therapy for candida infection

Answer 24

minimum of TWO WEEKS after first negative blood culture

Question 25

duration of therapy for mold infection

Answer 25

minimum of 12 WEEKS

Question 26

duration of therapy for HSV/VZV

Answer 26

7-10 days

Question 27

duration of therapy for influenza

Answer 27

AT LEAST 5 day course of oseltamivir

Question 28

duration of therapy for s.aureus

Answer 28

first get and ID consult and duration of therapy is usually 4 WEEKS after first NEGATIVE blood culture

Question 29

pt has neutroenic fever and has a mascc score of 16. they are not on fluroquinolne ppx. what should you treat them with

Answer 29

levaquin
amox/clauv and ciprofloxacin
moxifloxacin