Therapeutics - Toxicities of Chemo 1

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kyleannkelsey
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301857
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Therapeutics - Toxicities of Chemo 1
Updated:
2015-04-30 20:26:32
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Therapeutics Toxicities Chemo
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Therapeutics - Toxicities of Chemo
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Therapeutics - Toxicities of Chemo
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  1. Which drugs should not be given more than once every 6 weeks due to delayed recovery of the bone marrow?
    • BCNU
    • Lomustine (CCNU)
    • Mitomycin C
    • Alemtuzumab
    • Ibritumomab tiuxetan – onset 4-7 weeks after admin and may persist to 3 months
    • HD methotrexate – use leukovorin to prevent
  2. What drug is used in conjunction with Methotrexate to prevent myelosupression?
    Leukovorin
  3. You should expect onset of Neutropenia and Thrombocytopenia at what point with Alemtuzumab?
    • Neutropenia: 4 weeks after admin
    • Thrombocytopenia = 1 week after onset
  4. For a patient who has not received CSF prophylactically, but has developed neutropenic fever, you should consider treatment if they are:
    • > 65 years
    • Have sepsis syndrome
    • Severe ANC <100
    • Anticipated prolonged neutropenia
    • Pneumonia
    • Hospitalized
  5. When should you give CSF prophylaxis?
    • >20% risk of Neutropenic fever (High risk) – all patients
    • OR
    • Intermediate risk of 10-20% - consider the option
  6. Which chemotherapy drugs should never be accompanied by CSF and why?
    • Bleomycin = ABVS or BEACOPP
    • Enhances pulmonary toxicity
  7. When should phrophylactic CSF be given?
    24-72 hours after chemotherapy ends
  8. How long should CSF be given for?
    Until ANC is ~5000
  9. What are the major SE of CSF?
    • Bone pain – chest is common
    • Splenomegaly
    • Splenic rupture – if WBC is too high
  10. How can bone pain associated with CSF be ameliorated?
    • Give APAP
    • Opioids may be needed
    • Claritin has been reported to help
  11. What are the CSFs?
    • Filgrastin (g-csf)
    • Tbo-filgrastim
    • Filgrastim-sndz
    • Pegfilgrastim
    • Sargramostim (gm-csf)
  12. Which CSF is a biosimilar like drug?
    Tbo-filgrastim
  13. Which CSF is a true biosimilar?
    Filgrastim-sndz
  14. How are CSFs administered?
    • SQ – all drugs
    • IV – only original Filgrastim and Sargramostim, but SQ preferred
  15. What is a normal dose of CSF?
    • Filgrastims: 5 mcg/kg-10 mcg/kg
    • Neulasta: 6 mg x1 day after chemo
    • Sargramostim: 250 mcg/m2
  16. Filgrastim comes in what size vials?
    300 and 480 mcg
  17. Pegfilgrastim comes in what size of vials?
    6 mg syringe
  18. Sargramostim comes in what size vials?
    250 and 500 mcg vials
  19. When can you use Sargramostim?
    • When Filgrastim fails
    • OR
    • Post-AML induction
  20. When you treat neutropenic fever, what organism always need to be covered, due to exceptionally high risk of death?
    Pseudomonas
  21. What antibiotics cover pseudomonas and which ones are usually used for neutropenic fever monotherapy?
    • Aminoglycosides – gent, tobra, amik
    • Quinolones – cipro, levo
    • Aztreonam
    • Cefepime - USED
    • Ceftazidime – USED
    • Piperacillin-tazobactam (Zosyn) - USED
    • Carbapenems – imipenem, meropenem, doripenem - USED
  22. How should a patient with Neutropenic fever be treated?
    Inpatient with IV antibiotics
  23. What is used to evaluate risk of Neutropenic fever?
    • MASCC Risk-Index
    • < 21 = high risk
  24. What should you know about the situation when evaluating treatment for neutropenic fever?
    • Institution sensitivities
    • Patient allergies
    • Recent antibiotics used
  25. What treatment regimens are used for Neutropenic fever for patients with a history of pseudomonas or G- infection and are clinically unstable?
    • Dual QD therapy w/o Vancomycin
    • Aminoglycoside (gent, tobra, amik) plus one of these:
  26. Antipseudomonal penicillin: ticarcillin/clavulanate [Timentin®] or piperacillin/tazobactam [Zosyn®]
    • Antipseudomonal cephalosporin: cefepime [Maxipime®] or ceftazidime [Fortaz®]
    • Severe renal impairment: Use Cipro + an Antipseudomonal penicillin

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