Febrile Nutropenia (7 questions)

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alvo2234
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245526
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Febrile Nutropenia (7 questions)
Updated:
2013-11-06 21:25:40
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Hughes
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PT III exam
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  1. what is the normal ANC range
    1.5 to 8.0
  2. what is neutropenia
    • ANC < 0.5 or
    • ANC < 1.0 and predicted decline in < 48 hrs
  3. what is febrile neutropenia
    • neutropenia with fever >= 38.3 or 
    • 38.0 sustained for 1 hour
  4. when do you give antibiotic prophylaxis to FN patients
    if they are at high risk for prolonged neutropenia
  5. what antibiotic is used for prophylactic FN tx
    fluoroquinolones levo and cipro
  6. when is azole antifungal prophylaxis tx given
    • increased risk for candida:
    • HSCT
    • acute leukemia
  7. what antifungals are used for pts with increased risk for candida
    • fluconazole
    • itraconazole
    • voriconazole
  8. which drugs are used for aspergillis prophylaxis
    • AML
    • MDS
    • posaconazole
  9. which antiviral medication is used to prophylactically treat neutropenic pts
    acyclovir
  10. when can neutropenic pts on chemotherapy recieve a flu vaccination
    7 days after or 2 weeks prior to treatment
  11. when can transplant pts receive the flu vaccination
    > 6 months following transplant
  12. what are some of the risk factors for complications from FN
    • age > 65
    • previous episodes of FN
    • extensive prior tx
    • chemo
    • bone marrow involvement
    • poor nutrition
    • active infection 
    • advanced cancer
    • serious comorbidities
  13. how must posaconazole be taken
    with a high fat meal
  14. what are the high risk diseases and regimens
    • breast cancer (TAC= doc, dox, cyclophos)
    • lymphoma, non-Hodgkins Lymphoma
    • testicular cancer (bleomycin, etoposide)
  15. what is the brand name of filgrastim
    Neupogen
  16. how and when is neupogen given
    SQ daily (5mcg/kg) 300 or 480 vials
  17. when is neupogen give for chemo pts
    24  hrs after chemotherapy
  18. what is the brand name for pegfilgrastim
    neulasta
  19. how is neulasta administered
    6 mg SQ every 14 days
  20. how is neulasta given to cancer pts
    24 - 72 hrs after chemotherapy
  21. how is sagramostim given
    250 mcg/m2/day SC or IV over 24 hours beginning immediately following infusion of progenitor cells
  22. how long do you continue to give sagramostim
    until ANC is > 1.5 for 3 consecutive days
  23. what is considered high risk on the MASCC risk classification scale
    < 21
  24. Treatment assessment high and low risk pts
    anticipated > 7 days ANC < 100 w/ comorbidities (high risk)

    anticipated < 7 days ANC < 100 w/out comorbidities (low risk)
  25. when do you start empiric antibiotic therapy
    within 1-2 hours of presentation
  26. how do you empirically treat coagulase-negatice staphylococci
    vancomycin
  27. how do you empirically treat staphylococcus
    • vancomycin
    • linezolid
    • daptomycin
  28. how do you empirically treat streptococci
    vancomycin
  29. how do you empirically treat enterococci (faecalis and faecium)
    • ampicillin
    • piperacillin
    • imipenem
    • vancomycin
  30. how do you empirically treat VRE
    • linezolid
    • daptomycin
  31. which gene confers resistance to B-lactam and how would you treat those pts
    ESBL genes and you would give a carbapenem
  32. p. aeruginosa is resistant to which carbapenems
    • imipenem
    • meropenem
  33. which agents do you use for KPC producing agents
    • polymyxin-collistin
    • tigecycline
  34. what is the empiric treatment for high risk patients
    • cefepime
    • carbapenem (meropenem, imipenem/cilastin)
    • zosyn
  35. which antipsudomonal B-lactam agent should not be used for empiric treatment for high risk patients
    ceftazidime
  36. how do you treat a high risk patient with penicillin allergies
    • most can tolerate cephalosporins
    • cipro + clindamycin
    • aztreonam + vancomycin
  37. how do you empirically treat low risk patients
    • cipro + augmentin
    • levo
    • cipro
    • cipro + clindamycin (PCN allergy)
  38. when should vancomycin be considered
    • suspected catheter-related infection
    • SSTI
    • pneumonia
    • humodynamic instability
  39. how long should FN pts be treated who have an unidentified source
    • until afebrile for a least 2 days
    • ANC > 500
    • or 
    • cultures are negative for 48 hrs 
    • afebrile 24 hrs
  40. how long should FN therapy last for pts with documented infection
    10 - 14 days
  41. how do you treat a pt who is still neutropenic but has no fever after the 10 - 14 days of therapy
    FQN prophylaxis
  42. how do you modify tx for a pt with persistant fever
    • change cephalosporin to carbapenem
    • add AG, cipro or aztreonam
    • add vanco
    • add fluconazole
  43. how do you modify tx for a pt who has positive blood cultures (gram negative)
    • b-lactam or carbopenem
    • plus AG or FQN
  44. how do you modify tx for a neutropenic pt who has pneumonia
    • b-lactam or carbopenem 
    • plus AG or FQN
  45. when do you consider antifungal therapy when modifying treatment
    if the pt is HR and has a recurrent fever after 4-7 days
  46. agent of choice for antifungal empircal therapy
    ampho B, voriconazole, caspofungin
  47. which preemptive test is used for most fungi
    B-(1-3) D glucan test
  48. which preemtive test is used for aspergillus
    galactomannan test

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