15 Management of Side Effects

Question 1

What is the lifespan of circulating RBCs?

Answer 1

100-120 days

Question 2

What is the lifespan of WBCs?

Answer 2

13-20 days

Question 3

What is the lifespan of platelets?

Answer 3

8-10 days

Question 4

When is the nadir for lomustine?

Answer 4

35-45 days

Question 5

What is the most common dose limiting toxicity?

Answer 5

bone marrow suppression

Question 6

You can only give neulasta if there are how many days until next chemo?

Answer 6

14 at least

Question 7

What is a good platelet cutoff for surgery?

Answer 7

75-100

Question 8

What is a cutoff for SCD patients getting a transfusion?

Answer 8

6 or less, (10 if chronic transfusion protocol)

Question 9

What is the hgb transfusion parameter for a patient undergoing XRT?

Answer 9

10. oxygenated cells do better

Question 10

If hgb is less than 5, what is the appropriate transfusion rate?

Answer 10

5 ml/kg/dose over a 4 hour period. careful monitoring for fluid overload and cardiac failure.

Question 11

What does erythropoietin do?

Answer 11

a growth factor that promotes proliferation of erythrocytes. given subQ

Question 12

What are 3 internal flora that are often the cause of infection in a neutropenic child?

Answer 12

staph, e coli and candida. they can get these regardless of protective measures

Question 13

Fever in a patient with an implanted device is always significant. Name 3 implanted devices

Answer 13

CVAD, VP shunt, and artificial joint

Question 14

Most frequent source of CVAD infections?

Answer 14

gram pos bacteria, like staph.

Question 15

What is needed after 5-7 days fever/neutropenia?

Answer 15

fungal workup, usually with CT scan and antifungal coverage is started

Question 16

What does an AML patient/post transplant patient or someone with MRSA/skin infections need right away when febrile?

Answer 16

gram positive coverage/vanc

Question 17

Gut integrity is impaired due to bacterial infection - what coverage/ drugs are needed?

Answer 17

anaerobic - clindamycin or metronidazole

Question 18

What do you monitor with amphotericin when treating fungal infection

Answer 18

electrolytes - hypokalemia, severe reactions

Question 19

Treatment for varicella?

Answer 19

acyclovir/ganciclovir

Question 20

Possible SE of dapsone? (for PCP prophy)

Answer 20

methemoglobinemia - esp with G6PD

Question 21

Pt has painless ulcers, redness in mouth, mild soreness but no lesions. Which grade mucositis?

Answer 21

I.

Question 22

Mucositis is painful with redness, edema and ulcers, but pt can still eat/swallow. What grade?

Answer 22

II

Question 23

Mucositis is painful with ulcers requiring IV hydration, what grade?

Answer 23

III

Question 24

severe ulceration, TPN dependent mucositis is what grade?

Answer 24

IV

Question 25

How does oral care/rinses help mucositis?

Answer 25

Good dental and oral care may not prevent mucositis, but they have a major effect on severity of mucositis by decreasing the potential for secondary infections.

Question 26

What is an example of an NK1 receptor antagonist antiemetic?

Answer 26

Emend. usually used in combo with dex and zofran

Question 27

What drug class are promethazine and compazine? and reglan (metoclopramide)

Answer 27

dopamine antagonists, usually used for breakthrough N/V

Question 28

Large doses of ginger can inhibit what?

Answer 28

platelet production

Question 29

A patient taking steroids, TPN or asparaginase presents with nausea and right sided abd pain, what could it be?

Answer 29

pancreatitis. send amylase/lipase

Question 30

What do you do to treat pancreatitis?

Answer 30

NPO for gut rest, Opiods for pain management, when able to refeed do low fat diet. Can use pancreative enzymes to help. Even though TPN can cause it, it must be used during gut rest.

Question 31

Elevated transam/bili, coag issues, weight gain/edema, flu like symptoms and R side abdominal pain can be

Answer 31

Hepatitis (chemical or viral)

Question 32

Treatment for hepatitis?

Answer 32

fluid and electrolyte replacement, antipruritics, pain mgmt. steroids may decrease inflammation.

Question 33

What kind of diet for hepatitis?

Answer 33

low fat/high glucose

Question 34

What GI symptom can be caused by XRT to abd/pelv/lower spine

Answer 34

diarrhea

Question 35

What in neuroblastoma patients can cause diarrhea?

Answer 35

catecholamine release

Question 36

What are 2 meds to treat c diff

Answer 36

oral vanc, metronidazole

Question 37

What level of XRT is associated with permanent hair loss?

Answer 37

greater than 4000 cGy