Exam 2 - Oncologic Emergencies Part 2

Question 1

What is treatment for intermediate risk tumor lysis syndrome patients? (3)

Answer 1

hydration, allopurinol, and if hyperuricemic rasburicase

Question 2

What is treatment for high risk tumor lysis syndrome patients? (3)

Answer 2

hydration, rasburicase, and allopurinol AFTER rasburicase

Question 3

What is the MOA of allopurinol?

Answer 3

blocks the conversion of hypoxanthine to xanthine and xanthine to uric acid

Question 4

What is the MOA of rasburicase?

Answer 4

replacement enzyme that acts as urate oxidase to allow for uric acid conversion to allantoin

Question 5

What is the dosing for allopurinol in tumor lysis syndrome?

Answer 5

300 mg/m^2/day or 10 mg/kg/day PO in 3 divided doses q8 hrs

Question 6

What are the AEs of allopurinol?

Answer 6

generally well tolerated, SJS/TEN

Question 7

Which medication can be used in renal impairment when treating tumor lysis syndrome?

Answer 7

allopurinol

Question 8

What is the dosing for rasburicase?

Answer 8

1.5-3 mg IV, may repeat if uric acid remains 7.5+ mg/dL

Question 9

What are the AEs of rasburicase?

Answer 9

peripheral edema, skin rash, abdominal pain, constipation/diarrhea, hemolysis in G6PD deficiency

Question 10

What is a clinical pearl for rasburicase?

Answer 10

obtain a rasburicase uric acid; ice water bath to prevent rasburicase from continuing to degrade uric acid

Question 11

What are treatments for hyperkalemia as a result of tumor lysis syndrome? (6)

Answer 11

loop diuretics, calcium chloride/gluconate 1 g IV over 2-3 minutes, insulin 10U IV bolus, sodium bicarbonate 50 mEq IV, sodium polystyrene 15-60 g PO, hemodialysis or CRRT

Question 12

What are treatments for hyperphosphatemia as a result of tumor lysis syndrome? (5)

Answer 12

calcium acetate, calcium carbonate, aluminum hydroxide, lanthanum, sevelamer

Question 13

What is treatment for hypocalcemia as a result of tumor lysis syndrome?

Answer 13

do NOT treat unless symptomatic (calcium gluconate)

Question 14

Describe the incidence of febrile neutropenia?

Answer 14

typically occurs one week after chemo, risk factors include age 65+/gender/low BMI/previous chemo/comorbidities

Question 15

Define febrile neutropenia?

Answer 15

absolute neutrophil count <500 cells/µL OR <1000 and expected to drop to <500 in 48 hrs

Question 16

Define fever?

Answer 16

single temperature >38.3°C (100.9°F) OR temperature >38°C (100.4°F) for over 1 hr

Question 17

Who is considered low infection risk with regards to prophylaxis?

Answer 17

standard chemo for solid tumors, anticipated neutropenia <7 days

Question 18

Who is considered intermediate infection risk with regards to prophylaxis?

Answer 18

those with autologous transplants, non-solid tumors, purine analog therapy (e.g., fludarabine), anticipated neutropenia 7-10 days, CAR T-cell therapy

Question 19

Who is considered high infection risk with regards to prophylaxis?

Answer 19

allogeneic transplants, severe non-solid tumors, anticipated neutropenia >10 days

Question 20

Explain low infection risk with regards to prophylactic recommendations?

Answer 20

all none except viral if Hx HSV infection

Question 21

Explain intermediate infection risk with regards to prophylactic recommendations?

Answer 21

all consider during neutropenia and for viral possibly longer

Question 22

Explain high infection risk with regards to prophylactic recommendations?

Answer 22

for fungal and PJP consider during neutropenia, for bacterial during neutropenia and for viral possibly longer

Question 23

What are the bacterial prophylactic antimicrobials used for febrile neutropenia? (3)

Answer 23

levo/ciprofloxacin, cefpodoxime, penicillin VK (all PO)

Question 24

What are the fungal prophylactic medications used for febrile neutropenia? (3)

Answer 24

flu/posa/vori/itra/isavuconazole (PO), micafungin (IV), liposomal amphoterecin B

Question 25

What is the viral prophylactic medication used for febrile neutropenia?

Answer 25

acyclovir (PO)

Question 26

What is the antimicrobial used to cover PJP in febrile neutropenia?

Answer 26

sulfamethoxazole-trimethoprim (PO)

Question 27

What MASCC score is considered low risk? High risk?

Answer 27

low = <21, high = 21+

Question 28

What are treatments for low risk MASCC scores?

Answer 28

ciprofloxacin plus Augmentin (both PO bid), levo/moxifloxacin (PO qd)

Question 29

What are treatments for high risk MASCC scores?

Answer 29

cefepime, Zosyn, meropenem (all IV qid-tid)

Question 30

When should MRSA coverage be considered? (5)

Answer 30

patients with catheter-related infections, pneumonia, mucositis, SSTIs, hemodynamic insufficiency or sepsis

Question 31

What are treatments for MRSA coverage? (3)

Answer 31

vancomycin, linezolid, daptomycin

Question 32

What is the duration of therapy for unknown origin of infection in febrile neutropenia? (2)

Answer 32

neutrophils 500+ cells/µL = dscontinue, neutrophils <500 cells/µL = discontinue therapy/de-escalate to prophylaxis/continue regimen until neutropenia resolves

Question 33

What is the duration of therapy for documented SSTI in febrile neutropenia?

Answer 33

5-14 days

Question 34

What is the duration of therapy for Gram positive/negative bacteremia in febrile neutropenia?

Answer 34

7-14 day UNLESS S. aureus (4 weeks)

Question 35

What is the duration of therapy for bacterial sinusitis in febrile neutropenia?

Answer 35

7-14 days

Question 36

What is the duration of therapy for bacterial pneumonia in febrile neutropenia?

Answer 36

5-14 days

Question 37

What is the duration of therapy for a Candida infection in febrile neutropenia?

Answer 37

minimum 2 weeks

Question 38

What is the duration of therapy for a mold infection in febrile neutropenia?

Answer 38

minimum 12 weeks

Question 39

What is the duration of therapy for HSV/VZV in febrile neutropenia?

Answer 39

7-10 days

Question 40

What is the duration of therapy for influenza in febrile neutropenia?

Answer 40

minimum 5 days