All About G-CSFs!
This drug class is used to prevent bone pain in patients receiving G-CSF therapy.
What are second-generation antihistamines! (also NSAIDs)
The definition of a fever in a patient with febrile neutropenia.
What is a single oral temperature of ≥38.3 C (101 F) or temp >38 C (100.4 F) sustained over 1 hour?
Preferred OUTPATIENT treatment of low-risk FN patients typically involves combination therapy of amoxicillin-clavulanate and this drug.
What is levofloxacin/ciprofloxacin?
This type of vaccine is contraindicated in patients with febrile neutropenia.
What are live vaccines?
Patients are at the greatest risk of developing febrile neutropenia at this point in therapy.
What is the first cycle?
G-CSFs are given at least ___ hours after all chemotherapy has been administered.
What is 24?
This equation is used to calculate a patient's ANC.
What is Total WBC x (% neutrophils + % bands) / 100?
Preferred initial treatment of high-risk, hospitalized FN patients includes ________ as monotherapy.
What is an anti-pseudomonal beta-lactam? (pip/tazo, cefepime, aztreonam/vancomycin if severe PCN allergy)
Risk factors for febrile neutropenia. (Name 3)
What are advanced age (>65), advanced disease, poor performance/nutritional status, prior febrile neutropenic episodes, hematologic malignancy, low baseline blood counts, treatment with myelosuppressive chemotherapies, low BMI/BSA, dose-intense regimens, severe/prolonged mucositis, severe/prolonged cytopenia)?
This is the most common source of infection in patients with febrile neutropenia.
What is a patient's own flora? (it be your own body)
Neutrophil counts will reach their lowest (nadir) ____ days after chemotherapy is administered.
What is 7-10?
An ANC below this number is indicative of neutropenia.
What is 1500?
A hospitalized patient with high-risk FN is being treated with vancomycin. You’re a little confused by this, as vancomycin is not typically added first-line in these patients. What are some potential reasons for this? (Name 2)
Hemodynamic instability/sepsis, cellulitis/SSTIs, suspected MRSA pneumonia, known MRSA colonization, previous pneumococcal infection resistant to PCN/cephalosporins, and catheter-related bloodstream infections.
G-CSFs are avoided in this type of cancer to avoid stimulating tumor cell replication / cancer progression.
What is LEUKEMIA!
Coverage against this organism is indicated for ALL patients receiving antibiotics for febrile neutropenia.
What is PSEUDOMONAS!
A drop in neutrophils of up to ____% should be anticipated when discontinuing short-acting G-CSFs.
An ANC below this number is indicative of profound neutropenia.
What is 100?
Antibiotics are discontinued once patients meet these criteria. (Name at least 2, but there are 3 total)
What are 1) negative blood cultures after 72 hours, 2) resolved fever for at least 24 hours, and 3) ANC >500 unless a specific type of infection is found.
Coverage against these pathogens is added in persistently febrile patients that have not improved after 4 days of antibiotics.
What is 1 HOUR?
Sarah is a 25-year old patient with stage IV colon cancer undergoing treatment with FOLFOX. About 6 days into her current treatment cycle, she notices a fever of 101.2 and quickly presents to the closest ER like a good girl.
The medical resident is scared and wants to give all recommended treatments. He asks you, the pharmacist, to order whichever G-CSF is on formulary. How do you respond?
"Therapeutic G-CSFs are controversial and Sarah does not meet criteria. Initiating a G-CSF would likely not be helpful."
A "High-Risk" patient with febrile neutropenia has at least one of these features. (Name 3)
What are anticipated prolonged severe neutropenia, allogeneic HSCT, pneumonia or other complex infection, mucositis grade 3-4, use of highly myelosuppressive chemotherapies or targeted agents, hepatic or renal insufficiency, MASCC score <21, CISNE score ≥3, inpatient status at fever onset, significant medical comorbidity or clinical instability, uncontrolled or progressive cancer?
Sarah was recently diagnosed with acute leukemia and is scheduled to begin treatment today. Her oncologist asks you, the pharmacist, to select an antibiotic that will prevent PJP. Her drug allergies include sulfa antibiotics (anaphylaxis). Name at least 2 potential options.
What is atovaquone, dapsone, or pentamidine?
What are GRAM-POSITIVES!!!! We need vancomycin.
Soap (a Hodgkin Lymphoma patient) was recently discharged after a 10-day long hospital stay for febrile neutropenia. What is the best way to prevent another FN episode in future cycles?
1. Dose reduce her doxorubicin and cyclophosphamide.
2. Initiate post-chemotherapy pegfilgrastim with each cycle.
3. Start daily levofloxacin prophylaxis.
4. Initiate once-weekly pegfilgrastim until she finishes chemotherapy.
What is #2!!!!