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Why do oncology patients often have a central venous access device?
Why do oncology patients often have a central venous access device?
What characterizes febrile neutropenia in a patient?
What characterizes febrile neutropenia in a patient?
What is the primary concern regarding infection in febrile neutropenia patients?
What is the primary concern regarding infection in febrile neutropenia patients?
Which type of bacteria has the highest risk of causing sepsis in febrile neutropenia?
Which type of bacteria has the highest risk of causing sepsis in febrile neutropenia?
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What is often required if a patient's clinical condition does not improve after starting initial empiric antibiotics?
What is often required if a patient's clinical condition does not improve after starting initial empiric antibiotics?
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What defines a low-risk febrile neutropenia patient?
What defines a low-risk febrile neutropenia patient?
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Which antibiotic is considered appropriate for high-risk febrile neutropenia treatment?
Which antibiotic is considered appropriate for high-risk febrile neutropenia treatment?
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At what hemoglobin level should ESA therapy be initiated in chemotherapy-induced anemia?
At what hemoglobin level should ESA therapy be initiated in chemotherapy-induced anemia?
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Which of the following ESAs is considered a longer-acting agent?
Which of the following ESAs is considered a longer-acting agent?
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What is a significant risk associated with the use of ESAs in cancer patients?
What is a significant risk associated with the use of ESAs in cancer patients?
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What must be true before initiating ESA therapy for a cancer patient?
What must be true before initiating ESA therapy for a cancer patient?
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Which of the following statements about myelosuppression is accurate?
Which of the following statements about myelosuppression is accurate?
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Which statement is true regarding the treatment for anemia?
Which statement is true regarding the treatment for anemia?
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What is the primary cause of myelosuppression in oncology patients undergoing traditional chemotherapy?
What is the primary cause of myelosuppression in oncology patients undergoing traditional chemotherapy?
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What is referred to as the nadir in the context of myelosuppression?
What is referred to as the nadir in the context of myelosuppression?
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When should chemotherapy generally be administered to a patient considering their blood cell counts?
When should chemotherapy generally be administered to a patient considering their blood cell counts?
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What does the term 'absolute neutrophil count' (ANC) represent in the context of neutropenia?
What does the term 'absolute neutrophil count' (ANC) represent in the context of neutropenia?
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What is the normal platelet count range in cells/mm3?
What is the normal platelet count range in cells/mm3?
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Which of the following statements about the recovery of white blood cells and platelets post-chemotherapy is correct?
Which of the following statements about the recovery of white blood cells and platelets post-chemotherapy is correct?
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At what platelet count is the risk for spontaneous bleeding significantly increased?
At what platelet count is the risk for spontaneous bleeding significantly increased?
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What percentage of segmented and band neutrophils would indicate an ANC of 675 cells/mm3 if a patient's WBC is 4500 cells/mm3?
What percentage of segmented and band neutrophils would indicate an ANC of 675 cells/mm3 if a patient's WBC is 4500 cells/mm3?
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When should platelet transfusions be indicated for a patient?
When should platelet transfusions be indicated for a patient?
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Which complication is typically associated with myelosuppression from chemotherapy?
Which complication is typically associated with myelosuppression from chemotherapy?
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What is the role of transfusions in the management of severe cases of myelosuppression?
What is the role of transfusions in the management of severe cases of myelosuppression?
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What best represents the ANC for a patient with the following WBC counts: segmented neutrophils 60%, band neutrophils 10%, total WBC 600 cells/mm3?
What best represents the ANC for a patient with the following WBC counts: segmented neutrophils 60%, band neutrophils 10%, total WBC 600 cells/mm3?
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What would be the most appropriate course of action for a patient with neutropenia?
What would be the most appropriate course of action for a patient with neutropenia?
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Which factors increase the risk of chemotherapy-induced nausea and vomiting (CINV)?
Which factors increase the risk of chemotherapy-induced nausea and vomiting (CINV)?
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What is a patient-related risk factor for increased nausea and vomiting during chemotherapy?
What is a patient-related risk factor for increased nausea and vomiting during chemotherapy?
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What medication class should be avoided in patients who are thrombocytopenic?
What medication class should be avoided in patients who are thrombocytopenic?
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What is the emetogenic potential classification for a drug that has a 25% chance of causing vomiting without prophylaxis?
What is the emetogenic potential classification for a drug that has a 25% chance of causing vomiting without prophylaxis?
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How many days should patients be protected from nausea/vomiting when receiving highly emetogenic regimens?
How many days should patients be protected from nausea/vomiting when receiving highly emetogenic regimens?
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What term describes emesis that requires additional rescue medications even when prophylactic treatment has been administered?
What term describes emesis that requires additional rescue medications even when prophylactic treatment has been administered?
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Which of the following is true regarding patients receiving chemotherapy with minimal emetogenic potential?
Which of the following is true regarding patients receiving chemotherapy with minimal emetogenic potential?
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Which approach is recommended for treating breakthrough nausea and vomiting?
Which approach is recommended for treating breakthrough nausea and vomiting?
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What is a key principle for managing CINV during chemotherapy with moderately emetogenic agents?
What is a key principle for managing CINV during chemotherapy with moderately emetogenic agents?
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Which is true regarding the administration of antiemetics for CINV?
Which is true regarding the administration of antiemetics for CINV?
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During which chemotherapy cycles should patients expect to experience refractory emesis?
During which chemotherapy cycles should patients expect to experience refractory emesis?
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Which class of medication is primarily used for preventing and treating chemotherapy-induced nausea and vomiting (CINV)?
Which class of medication is primarily used for preventing and treating chemotherapy-induced nausea and vomiting (CINV)?
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Which medication is commonly associated with the risk of tardive dyskinesia when used for an extended duration?
Which medication is commonly associated with the risk of tardive dyskinesia when used for an extended duration?
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Which of the following medications is classified as a NK1 antagonist for CINV treatment?
Which of the following medications is classified as a NK1 antagonist for CINV treatment?
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In the management of refractory or delayed CINV, which cannabinoids are indicated?
In the management of refractory or delayed CINV, which cannabinoids are indicated?
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Which of the following constitutes an appropriate antiemetic regimen for a patient undergoing cisplatin-based therapy?
Which of the following constitutes an appropriate antiemetic regimen for a patient undergoing cisplatin-based therapy?
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What common side effect is associated with the use of benzodiazepines in CINV treatment?
What common side effect is associated with the use of benzodiazepines in CINV treatment?
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Which medication is frequently used as an adjunct alongside antiemetics, specifically lorazepam?
Which medication is frequently used as an adjunct alongside antiemetics, specifically lorazepam?
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What is a significant side effect of both dronabinol and nabilone when used for CINV?
What is a significant side effect of both dronabinol and nabilone when used for CINV?
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Study Notes
Oncology Supportive Care
- Oncology supportive care is a field focused on managing side effects of cancer treatment.
Myelosuppression
- Myelosuppression is a common side effect of chemotherapy.
- It reduces bone marrow activity, resulting in lower counts of red blood cells (RBCs), white blood cells (WBCs), and platelets.
- Bone marrow suppression is the most common dose-limiting toxicity associated with traditional cytotoxic chemotherapy.
- Nadir is the lowest point WBCs and platelets reach, usually 7-14 days after chemo.
- RBC nadir is much later (several months) due to RBC lifespan (120 days).
- WBCs and platelets generally recover 3-4 weeks post-treatment.
- The next chemo dose is given when WBC count is >3000 cells/mm³ or ANC >1000 cells/mm³ and platelet count is >100,000 cells/mm³.
- Recovery time varies, and some cases may require transfusions if necessary.
- Neutropenia (low neutrophils), a type of leukopenia (low WBCs), is assessed by the absolute neutrophil count (ANC).
- Higher ANC, lower risk of infection.
- ANC calculation: WBC x (percentage segmented neutrophils + percentage band neutrophils)
Neutropenia
- Neutropenia is defined as an ANC ≤500 cells/mm³ or a count of ≤1000 cells/mm³, with a predicted decrease to less than 500 cells/mm³ during the next 48 hours.
- Risk of infection increases with lower ANC.
- Growth Colony Stimulating Factors (G-CSFs) stimulate WBC production and can prevent or reduce infection risk, not necessarily treat.
- Patients with >20% chance of developing febrile neutropenia should receive a G-CSF.
Anemia
- Hemoglobin (Hgb) levels assess anemia.
- Normal Hgb levels are 12-16 g/dL for females and 13.5-18 g/dL for males.
- Anemia can resolve without treatment, be treated with RBC transfusion, or erythropoiesis-stimulating agent (ESA).
- Avoid ESAs for patients receiving curative chemo; ESAs may shorten survival or increase tumor progression. In order to use ESAs appropriately, two months of planned additional chemo is required prior to starting ESA's AND Hgb must be less than 10g/dL. Iron levels should also be evaluated for effectiveness of treatment.
Thrombocytopenia
- Low platelets (thrombocytes) can cause spontaneous, uncontrolled bleeding.
- Normal range is 150,000-450,000/mm³.
- Platelet transfusion indicated when counts <10,000 cells/mm³ (or <30,000 if active bleeding).
- Avoid IM injections, NSAIDs, while platelet count is low.
Chemotherapy-Induced Nausea and Vomiting (CINV)
- Patient factors increasing risk: Female gender, age < 50, anxiety/depression, history of motion sickness or CINV with prior chemo, dehydration
- Agent related factors:
- High emetogenic potential: >90% vomiting chance
- Moderate: 30-90%
- Low: 10-30%
- Minimal: <10%
- CINV types: Acute (day 1, emesis peaks 5-6 hours after chemo); Delayed (days 2-5, peak emesis 48-72 hours after chemo)
- Breakthrough emesis: Occurs despite prophylaxis or needs rescue meds.
- Refractory emesis: Emesis during treatment cycles when prophylaxis or rescue failed in previous cycles.
Managing CINV
- Prophylactic antiemetics: administered before moderately or highly emetogenic chemo or radiation.
- Patients with low emetogenic chemo should get a single dose
- Patients with minimal emetic risk don't need prophylaxis.
- Antiemetics scheduled for delayed nausea and vomiting.
- Patients need protection throughout the full period of risk.
General Principles
- Oral and IV antiemetics are equally effective, but choice depends on patient factors like taking oral meds, form availability, and cost.
- Patients undergoing chemo should have antiemetics available to treat breakthrough N/V.
- If breakthrough CINV occurs, use a different antiemetic with a different mechanism.
Anti-emetic Regimen Examples
- These are examples from the slides, not a comprehensive list
- High emetic risk: NK1-RA + 5HT3-RA + Olanzapine + Dexamethasone
- Moderate emetic risk: NK1-RA + 5HT3-RA + Dexamethasone
- Low emetic risk: 5HT3-RA + Dexamethasone
- Specific drugs and dosages covered in the medication sections
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Description
Test your knowledge on oncology supportive care, focusing particularly on myelosuppression and its impact during chemotherapy. This quiz covers important concepts such as nadir, recovery times, and the management of side effects related to cancer treatments.