Random 2 Flashcards
ANC equation
ANC = WBC * (% seg neuts + % bands)
Neutropenia ANC < 500
Must have ANC > 1500 to be eligible for chemotherapy
Dexrazoxane
Prevent cardiomyopathy in doxorubicin > 300 mg/m2
Give 10% of doxo dose as dexrazoxane
Also used for extravasation
Amifostine
Use for nephrotoxicity from cisplatin
Leucovorin
Use after MTX doses > 1000, rescue tx in MTX > 500
Can add on glucarpidase but do not administer leucovorin 2 hours before or afterwards
Tumor lysis syndrome
Rasburicase tx, use allopurinol or fluids as prophylaxis
Increased uric acid
Hypercalcemia (cancer related)
Ca > 14
Fluids, loop diuretics, bisphosphonates, calcitonin
Corrected Ca equation
= (4-albumin)* 0.8 + Ca
Normal is 12-14
use if albumin < 3.5
Leapfrog Hospital Safety Grades
VA hospitals, critical access hospital excluded
Issued 2x per year
Barcode scanning on med admin one of the criteria - goal is to reduce preventable mistakes
HEDIS
NCQA - part of CMS
Not required to report to HEDIS, but used for ratings
IRB required members
5 members
1 scientific, 1 nonscientic, 1 not affiliated with org, and one that represents perspectives of research participants
Cost Benefit
Cost effectiveness
Cost minimize
cost utilization
Cost Benefit: Looks at tx + costs saved with benefit outcomes
Cost effectiveness: Looks at measured clinical uses or outcomes (years of lives saved)
Cost minimize: Compares therapies
Cost utilization: Looks at mortality / QALY
ivabradine (Corlanor)
Used in HF EF < 35% and on max tolerated BB with HR > 70 bmp.
ADE: bradycardia, atrial fibrillation, HTN
Lowers hospitalizations
Criteria for antibiotics in COPD
Dyspnea OR increase sputum volume
+ increased sputum purulence
OR mechanical ventilation
Augmentin, macrolide, doxycyline if GOLD 1 or 2
Levo/cipro if GOLD 3 or 4 (pseudo coverage)
Theoyphilline
MOA - phosphodiesterase inhibitor, methylxanthine. No longer recommended for acute tx of asthma
Can lower seizure threshold
FEV cut-off's GOLD 1 GOLD 2 GOLD 3 GOLD 4
GOLD 1 >= 80%
GOLD 2 50-79%
GOLD 3 30-49%
GOLD 4 < 30%
Pneumococcal vaccine recommendations
Age 19-64 w/ chronic medical condition (give if FEV1 < 40%) - 1 dose of PPSV23
Immunocompromised > 19 yoa: 1 dose PPSV13, 8 weeks later PPSV23, then 5 years later booster PPSV23
65 and older - PPSV 13 and PPSV 23 one year later
Hyponatremia
If due to dehydration, give NaCl 0.9%, check in q4h
Na < 120, symptomatic - use hypertonic saline NaCl 3%
1 mEq/L/hr (severe), 0.5 mEq/L/hr in moderate. Can give NaCl 0.45% to slow down the rise.
Do not correct more than 10-12mEq per 24 hours, or > 18 mEq in 48 hours.
Treating hypokalemia will help increase Na as well! If Euvolemic or edematous, fluid restriction (<800mL/day) or vasopressin antagonists like tolvaptan
Med induced = thiazides, antiepileptics, SSRI’s, hypothyroid, SIADH
Hypernatremia
Na > 145 - caused by dehydration, sodium retention, brain injuries. Requires H2O! Must give by mouth or via D5W, never SW infusion!
If hypotensive, can give NaCl 0.9%
Hypokalemia
K < 3.5
Causes: insulin, beta agonists (albuterol), alkalosis, hypothermia, diuretics, GI losses
K 3-3.5 –> PO KCl 40-80 mEq/day
K 2-3 –> IV or PO (IV 10-20 mEq/hr)
K < 2 give 20 - 40 mEq/hr IV (ECG monitor)
Divide doses > 60 mEq to reduce GI SE
Max peripheral IV is 60-80 mEq
Don’t mix K in dextrose
Hyperkalemia
K > 5; if > 6.5 it is an emergency !
If symptomatic:
- Calcium gluc 1 g IV push to reduce cardiac risk
- Insulin 10 units IV + 25-50 g glucose via 50% IVpush
- Sodium bicarbonate 50 mEq IV push
- Albuterol 10-20 mg neb (if on BB, pt will not respond - not as effective)
If asx, give sodium polystyrene sulfonate alone 15 g q6h
Causes: succ, K sparing diuretics, acei, arbs, trimethoprim. If CAD, CHF, DM - higher risk of sudden death
Hypomagnesium / hypermagnesium
Mg < 1.7
Oral supplementation, mag oxide - SE is diarrhea
1-4 g slow IV infusion, lower dose by 50% in renal
Can give push if emergency
Mg > 2.3
0.9% NaCl, loops, IV calcium if sx
Hypocalcemia
Corrected Ca if Ca < 8.5 Sx: muscle twitch/seizure CaCl 1g via central line CaGluc 2-3 g via peripheral line max rate 60 mg/min
Hyperpcalcemia
Due to malignancy: NaCl 0.9% plus bisphosphonate (zolendronic acid 4 mg IV - can take up to 7 days for nadir to be reached) + calcitonin (if symptomatic)
Medicare Access and CHIP Reauth Act (MACRA)
Fee for service to a value-based or pay for performance model
