Exam 5 - Immunocompromised Host Flashcards Preview

Therapeutics V Spring 2019 (P3 Spring) > Exam 5 - Immunocompromised Host > Flashcards

Flashcards in Exam 5 - Immunocompromised Host Deck (31):
1

Neutropenia = an ________ less than _______/mm3

an ANC (absolute neutrophil count)
less than 1000

2

how to find ANC?

WBC x (% polys + % bands)

3

what are important risk factors related to neutropenia

severity of neutropenia
rate of neutrophil decline
duration of neutropenia

4

High risk of infection in pts with ANC < _______

500 cells/mm3

5

Risk of infection and death are greatest in pts with ANC < ________

100 cells/mm3

6

Cell mediated or Humoral immunity defects?
defects in t lymphocyte and macrophage

cell mediated

7

Cell mediated or Humoral immunity defects?
defects in B cell function

humoral

8

Cell mediated or Humoral immunity defects?
results in reduced ability of the host to defend against intracellular pathogens

cell mediated

9

Cell mediated or Humoral immunity defects?
common bacteria pathogens found include ATYPICALS! (listeria, nocardia, legionella, mycobacteria)

cell mediated

10

Cell mediated or Humoral immunity defect?
common pathogen = fungi

cell mediated

11

Cell mediated or Humoral immunity defects?
common pathogens include S. pneumoniae, H. influenzae, N. meningitidis

humoral

12

most infections in cancer patients are caused by oraganisms that are colonized where?

skin
oropharynx
and GI tract

13

Clinical presentation in neutropenic patients?

presence of fever - probably ONLY clinical finding
(wont see white cells because they are NEUTROPENIC!!)

14

Patient factors for being low risk for infections:
-neutropenic for < ____ days
-no or few ____________
-clinically stable at ________
-no identified focus of infection/simple infection

-neutropenic for < 7 days;
-comorbidities
-onset of fever

15

Patient factors for being high risk for infections:
-profound/prolonged _________
- significant ________

-neutropenia = ANC < 100 and > 7 days
- comorbidities

16

If pt is low risk for infection and has neutropenia:
if pt has adequate outpt infrastructure (phone and transport) AND can do oral regimen.... what do you give them

cipro + amox/clav

17

If pt is low risk for infection and has neutropenia:
if pt has INadequate outpt infrastructure (phone and transport) OR can NOT do oral regimen.... what do you give them

IV abx MONOTHERAPY

18

what are the IV abx that are used in febrile neutropenic patients -- LOW RISK

pip/tazo
antipseudomonal carbapenem (AKA not erta)
Cefepine
Ceftazidime

19

If pt is high risk for infection and has febrile neutropenic: what do you give them?

IV abx (monotherpapy)

20

what are the IV abx that are used in febrile neutropenic patients -- HIGH RISK

same as LOW RISK!!
pip/tazo
antipseudomonal carbapenem (AKA not erta)
Cefepine
Ceftazidime

21

when patient is high risk febrile neutropenia:
add Vanc when?

cellulitis, pneumonia, severe sepsis/shock
known colonization with MRSA or resistant streptococci, or gram POSITIVE bacteremia

*duh no vanc needed for gram -

22

when patient is high risk febrile neutropenia:
if septic shock or gram - bacteremia or pneumonia add what drugs?

add aminoglycosides OR antipseudomonal FQ

consider anti fungal for septic shock

23

if pt has MRSA: consider early addition of what drugs?

vanc, linezolid, or daptomycin

24

if pt has VRE: consider early addition of what drugs?

early addition of linezolid or daptomycin

25

if pt has ESBL: consider early addition of what drugs?

consider early use of carbapenem

26

if pt has KPC producer: consider early addition of what drugs?

colistin in combo
or ceftazidime/avibactam

27

when to add antifungal therapy to neutropenic patients?

when pts remains febrile with undocumented infection after 4 - 7 days of broad spec abx

28

if pt has HSV/VZV --- give what drug?

acyclovir

29

if pt has CMV --- give what drug?

ganciclovir

30

what neutropenic people need antifungal prophylaxis

people getting allogenic HSCT (hematopoietic stem cell transplant)

pts undergoing intensive remission induction or salvage induction chemo for acute leukemia)

31

when to do antiviral prophylaxis?

acyclovir prophylaxis in HSV seroPOSITIVE pts who are geting a HSCT or leukemia infuction therapy