Supportive care Flashcards
Indications for prmiary prophylaxis of GCSF
Expected neutropenia of > 20%
pateient > 65 years with agressive lymphoma and curative intent
Indications for secondary prophylaxis of GCSF
Previous episode of neutropenic fever if reduced dose intensity might compromise treatment outcome
GCSF for neutropenic fever
Prolonged (>10 days) or profound (<100 cells/microL) neutropenia, age >65, pneumonia or other clinically documented infections, sepsis syndrome, invasive fungal infection, prior episode of febrile neutropenia, or being hospitalized at the time of the development of fever.
GCSF for neutropenic fever
Prolonged (>10 days) or profound (<100 cells/microL) neutropenia, age >65, pneumonia or other clinically documented infections, sepsis syndrome, invasive fungal infection, prior episode of febrile neutropenia, or being hospitalized at the time of the development of fever.
Paloxi dosage
IV 0.25 mg- 30 min prior to chemo
There is no oral drug in Israel
Paloxi dosage
IV 0.25 mg- 30 min prior to chemo
There is no oral drug in Israel
Paloxi side effect
CV- Bradycardia, 1st degree AVB, QT prolongation- risk is minimal even with X9 dosage.
Hypersnsitivity
Serotonin syndrome- combination with SSRI, SNRI, Miro
Paloxi half life
~40 hours
Akynzeo dosage
1 capsule-
Netupitant 300 mg and
Palonosetron 0.5 mg
1 hour prior to chemo
Akynzeo dosage
1 capsule-
Netupitant 300 mg and
Palonosetron 0.5 mg
1 hour prior to chemo
Akynzeo half life
80 hours
Akynzeo bioavailavbilty
97%
Akynzeo Time to peak
~4-5 hours
Pramin side effects
Anxiety Depression Restlessness Akathisia Dystonia Tardive dyskinesia
5-HT3 blockers
Ondansetron
Granisetron
Dolasetron
Palonosetron
5-HT3 side effects
Headache
NK1 receptor antagonists
Oral aprepitant
IV fosaprepitant
Oral netupitant (combined with palonosteron in Akynzeo)
Oral rolapitant
Metabolism of NK1 antagonists
CYP3A4
resulting in a need for many dose reductions of medications
Dosage of GCSF
Filgrastim (Neupogen, Tevagrastim)- 5 mcg/kg/day for up to 14 days
Pegfilgrastim- (Fulphila)- 6 mg once- 24 hours after end of chemo
GCSF side effects
Osteoalgia Capillary leak syndrome ARDS Aortitis Cutaneous vasuculitis Gleumerolunephritis Splenic rupture MDS
Filgrastim time of onset
1-2 days
Evusheld machanism fo action
Tixagevimab and cilgavimab
Human IgG1κ monoclonal antibodies
Evusheld dosage
300 mg /300 mg
every 6 months
