UNM Heme/Onc

How does ALL typically present?
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Terms in this set (20)
1) Clinically worsening despite Cefepime
2) Gram positive bacteria in blood culture while awaiting ID and susceptibility
3) Catheter-related blood stream infection evidenced by cellulitis around catheter entry sit, or chills/rigors with infusion through central line lumen
4) Skin and soft tissue infection
5) Severe oral mucositis or recent exposure to high dose Ara-C
What is the discharge criteria for a patient with neutropenic fever? (List 6 reasons)1) Negative blood cultures for at least 48 hours 2) Afebrile for at least 24 hours 3) Evidence of marrow recovery (ANC rising) 4) No signs of localized infection 5) Performance scale rising back to baseline 6) Around the clock caregiver available at home, at least 1 hour from the hospitalWhat are the 4 most common chemotherapy complications?1) Mucositis: Chemo impairs ability of mucosal lining to regenerate. Most commonly associated with methotrexate and anthracylcines. Treat with Maalox + Benadryl +/- Lidocaine. 2) Pain: Can be from chemo or tumor, treat with narcotics. Do NOT give tylenol due to potential to mask fever. 3) Neuropathy: Stocking glove pattern, associated ankle pain, foot drop/tripping 4) Cytopenias: Due to bone marrow suppression by chemo. Ask attending who gets GCSFWhat are the most common cancers associated with Tumor Lysis Syndrome (TLS)?1) Burkitt's Lymphoma 2) Lymphoblastic Lymphoma 3) Acute Lymphoblastic Leukemia (T-Cell) 4) Blue Round TumorWhat are the main metabolic abnormalities associated with TLS?1) Hyperkalemia (>6) 2) Hyeruricemia 3) Hyperphosphatemia (>6.5) 4) Hypocalcemia (<1.5)What is the hydration strategy for the management of TLS?D5 1/4NS + 20-40 mEq/L of NaHCO3 at 2-4x maintenance to maintain the following: 1) Urine Specific Gravity <1.010 2) Urine Output >100 mL/m2/hr 3) Urine pH 6.5-7.5What is the management of TLS induced Hyperuricemia?-Allopurinol (prevents formation of uric acid by inhibiting xanthine oxidase) -Rasburicase (breaks down uric acid into allantoin)What condition is Rasburicase contraindicated in?G6PD DeficiencyWhat is the management of TLS induced Hyperkalemia? (List 6 items)1) NO K IV/PO 2) NaHCO3 1-2 meq/kg/IV 3) Insulin and glucose 4) Calcium chloride 5) Kayexalate 6) Dialysis if all else failsWhat is the management of TLS induced Hyperphosphatemia? (List 3 items)1) Restrict phosphate in diet (dairy, coke, peanut butter are big ones) 2) Use phosphate binders (amphogel and renagel) 3) Maintain Urine Output greater than 3mL/kg/hrWhat is the management for TLS induced Hypocalcemia?Give 10mg/kg of elemental Ca for symptomatic hypocalcemia.