CINV
This is the first thing you should determine before selecting an antiemetic prophylaxis regimen.
What is "the antiemetic risk of the chemotherapy regimen?"
This growth factor class is commonly used to reduce the risk of chemotherapy-associated febrile neutropenia.
What is "G-CSF"? or pegfilgrastim/filgrastim is acceptable
This infection should be on your differential when a patient develops significant watery diarrhea after antibiotic exposure.
What is "Clostridioides difficile" infection?
Patient is receiving chemotherapy and states "I'm nauseated". You have 10 seconds. What do you ask first?
Allergies, when did it start?, what chemo emetogenecity, what antiemetics have already been received, etc
What class is ondansetron?
5 seconds - GO!
5-HT3 antagonist
This class of antiemetic blocks the serotonin receptor responsible of much of acute chemotherapy-induced nausea and vomiting.
What is a "5-HT3 receptor antagonist?"
Giving a growth factor before the patient ever develops neutropenia is called this.
What is "primary prophylaxis"?
According to NCCN, this drug is preferred for initial CDI episode.
What is "fidaxomicin"?
Patient is starting chemotherapy with substantial FN risk. The Oncologist asks "do we wait until they become neutropenic"? Yes or No? Why?
No. Key is to "prevent" n/v. Much easier to prevent than to wait and try to treat after it occurs
What dose G-CSF stimulate?
5 seconds... GO!
Neutrophil production
A patient receiving highly emetogenic chemotherapy receives a 5-HT3 antagonist alone. What is the major problem?
What is "inadequate prophylaxis/insufficient combination therapy for the regimen's risk?"
A patient previously experienced febrile neutropenia during chemotherapy. Giving growth factor support during subsequent cycles is an example of this.
What is "secondary prophylaxis"?
Acceptable alternative to fidaxomicin for initial CDI.
What is "Oral vancomycin"?
Cancer patient develops diarrhea. The resident states that "it's probably the chemotherapy". Do you agree?
Could be from the chemo and could be c.diff infection and could be from other medications or causes. You would have to assess and ask more questions.
Common G-CSF adverse effect?
5 seconds...GO!
bone pain
A patient develops vomiting despite receiving appropriate prophylaxis. You should think about this concept rather than simply repeating the prophylactic regimen.
What is "breakthrough CINV management?"
Your patient asks why they shouldn't receive their growth factor at the same time as chemotherapy.
What is "appropriate timing relative to the cytotoxic chemotherapy"?
An immunocompromised patient with CDI should make you particularly concerned about this.
What is "recurrence"?
The patient is receiving NK1 antagonist and dexamethasone. You notice a potential interaction. What do you do?
NK1 antagonists increase the levels of dexamethasone. It used to be that we could give 20mg and 40mg IV dex doses, however, over the last couple of years the doses have decreased d/t this interaction. Now we give 12mg for most regimens but no more than 20mg should be given with the NK1
What is the preferred agent for initial CDI when appropriate?
5-seconds....GO!
fidaxomicin
A patient is receiving highly emetogenic chemotherapy and already takes several medications metabolized through CYP pathways. What are two things you should consider before finalizing the antiemetic regimen?
Appropriate antiemetic intensity based on chemotherapy emetogenecity. Drug-drug interactions. Dexamethasone interactions/dosing. Patient-specific risk factors. Prior CINV, female, young, etc
Your patient calls after receiving G-CSF and says "My bones hurt so badly I think something is seriously wrong". Name the "common adverse effect" and the one thing you would assess.
What is "Bone pain"? - assess severity and consider other concerning symptoms/complications. Are they taking their loratadine, etc.
Chemotherapy, prolonged hospitalization, GI surgery, advanced age and PPI's are considered...
What are "risks for CDI"?
You are called about a patient with highly emetogenic chemotherapy, previous FN, immunocompromised status, recent broad-spectrum antibiotics, and new watery diarrhea. The MD states "I need a plan and you have 60 seconds"...
CINV ppx (4-drug regimen), FN prevention (Primary ppx), diarrhea/CDI evaluation/testing, drug interactions, monitoring > if positive, then what?
Major risk factor for recurrent CDI in our patients?
5 seconds...GO!
Immunocompromised