Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Clinical Applications Group 10

No description
by

Michelle Krupka

on 16 September 2010

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Clinical Applications Group 10

Neutropenia Lindsey Jenkins
Marla Koch
Michelle Krupka
Erin Laskowski
Tara Lindeman What is What is Febrile Neutropenia? Neutropenia: less than or equal to 500 cells/mm^2 characterized by: one time fever of 101 °F
fever of 100.4 °F or higher for more than an hour Hughes WT, Armstrong D, Bodey EJ, et al. 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases. 2003; 34:730-750.

Picture found at: http://3.bp.blogspot.com/_DYuMKygnE2Y/TDLPaAnqSJI/AAAAAAAAANk/gcRiNYavd4Q/s1600/fever.gif Treatment: access patient’s risk for complications using the MASCC Low Risk Patient (meets criteria for outpatient therapy)
Low Risk Patient (does not meet criteria for outpatient therapy)
High RIsk Patient Hughes WT, Armstrong D, Bodey EJ, et al. 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases. 2003; 34:730-750. MASCC Risk
Score Categories Multinational Association for Supportive Care in Cancer Categories Include: systolic blood pressure is greater than 90
active COPD (bronchitis, emphysema)
solid tumor
requires IV fluids due to dehydration
had previous fungal infection
in clinical setting at onset of fever
older than 60 years old Hughes WT, Armstrong D, Bodey EJ, et al. 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases. 2003; 34:730-750. Outpatient Therapy Criteria neutrophil count: 100 cells/mm^2
monocyte count: 100 cells/mm^2
normal hepatic & renal function tests
neutropenia expected to resolve within 10 days
no IV or catheter-site infections
no history of fungal infections
evidence of bone marrow recovery
no appearance of illness, abdominal pain, mental changes, or blood loss Hughes WT, Armstrong D, Bodey EJ, et al. 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases. 2003; 34:730-750. Low Risk Patient: Criteria: score of 21 or lower on MASCC
qualify for outpatient therapy Treatment: combined oral antibiotic therapy
ciprofloxacin & amoxicillin-clavulanate Low Risk Patient (not eligible for outpatient therapy) Option 1: Option 2: single drug therapy
includes cephalosporin: ceftazidime or cefepime
or carbapenum: imipenem-cilastatin or meropenem
depending on type of bacterial infection two-drug therapy without vancomycin
includes aminoglycoside as well as: antipseudomonal carboxypenicillin,
antipseudomonal cephalosporin,
or a carbapenem Hughes WT, Armstrong D, Bodey EJ, et al. 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases. 2003; 34:730-750. (eligible for outpatient therapy) High Risk Patient treated with vancomycin
may be treated also with other drugs like linezolid or ticarcillin depending on type of infection
monitored for no response to antibiotic, adverse medication effects, or development of drug-resistant organisms
reassessed in 3-5 days Hughes WT, Armstrong D, Bodey EJ, et al. 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases. 2003; 34:730-750. Hughes WT, Armstrong D, Bodey EJ, et al. 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases. 2003; 34:730-750. Hughes WT, Armstrong D, Bodey EJ, et al. 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases. 2003; 34:730-750. Prevention 3 Colony Stimulating Factors Neupogen (filgrastim)
Neulasta (pegfilgrastim)
Leukine (sargramostim) Hughes WT, Armstrong D, Bodey EJ, et al. 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases. 2003; 34:730-750. Prophylaxis: Primary: prevention for high risk patients
based on age, medical history, disease characteristics & myelotoxicity of chemotherapy regimen Secondary: for patients with complications after chemotherapy & never received primary
prophylaxis alternative-dose reduction or delay Smith TJ, Khatcheressian J, Lyman GH, et al. 2006 Update of Recommendations for the Use of White Blood Cell Growth Factors: An Evidence-Based Clinical Practice Guideline. Journal of Clinical Oncology. 2006; 24(19):3188, 3191 Colony Stimulating Factors: preferred route is subcutaneous administration as prophylactics on same day as chemotherapy is not recommended Clinical Practice Guidelines in Oncology. Myeloid Growth Factors. National Comprehensive Cancer Network. 2010; 1: MGF-C National Comprehensive Cancer Network of Evidence & Consensus Category 1: high level of evidence & uniform consensus
Category 2A: lower level of evidence & uniform consensus
Category 2B: lower level of evidence & non-uniform consensus
Category 3: any level of evidence but major disagreement Clinical Practice Guidelines in Oncology. Myeloid Growth Factors. National Comprehensive Cancer Network. 2010; 1: MS-1 Filgrastim Neupogen
category 1
5 mcg/kg daily
begin treatment 24-72 hours after chemotherapy completion
treat through post-nadir recovery Outline: What is Febrile Neutropenia?
Prevention Agents
Possible Side Effects
Vignette
Treatment
Counseling a Patient
Questions Pegfilgrastim: Neulasta
prophylactic use only
6 mg per cycle of treatment
begin treatment 24-72 hours after chemotherapy completion
Category 1 evidence suggests regimen given every 3 weeks
Phase II studies show efficacy in regimens given every 2 weeks
not recommended for chemotherapy schedules less than 2 weeks due to insufficient data Clinical Practice Guidelines in Oncology. Myeloid Growth Factors. National Comprehensive Cancer Network. 2010; 1: MGF-C Sargramostim: Leukine
Category 2B
clinical trials: 250 mcg/m^2 daily
begin treatment 24-72 hours after chemotherapy completion
treat through post-nadir recovery Clinical Practice Guidelines in Oncology. Myeloid Growth Factors. National Comprehensive Cancer Network. 2010; 1: MGF-C

Picture found at: http://dailymed.nlm.nih.gov/dailymed/archives/image.cfm?archiveid=17435&type=img&name=leukine-figure-2.jpg Clinical Practice Guidelines in Oncology. Myeloid Growth Factors. National Comprehensive Cancer Network. 2010; 1: MGF-C

Picture found at: http://www.drug3k.com/img2/neupogen_10724_5_(big)_.jpg Side Effects Vignette Counseling: Questions: Febrile Neutropenia: a) is characterized by a fever
b) can be prevented with Colony Stimulating Factors
c) has 3 types of treatment based on the patient's risk factor
d) all of the above
e) none of the above Which are colony
stimulating factors? I. Oseltamivir
II. Neulasta
III. Leukine
IV. Neupogen

a) I, II, & III
b) II, III, & IV
c) I, II, III, & IV Questions? Filgrastim Pegfilgrastim Sargramostim Allergic reactions
Adult Respiratory Distress Syndrome
Splenic rupture
Sickle cell disease
Tumor Growth Factor
Cytogenic abnormalities occur with those who have had longer treatments
Reactions more frequent with IV administration
Usually within the first 30 minutes Similar symptoms/risks as Filgrastim
Allergic Reactions
Bone pain
Adverse Reactions not as common
Acute Respiratory Distress Syndrome
Splenic rupture
Typically occur when first dose is given Fluid retention
Dyspnea
Important to monitor blood counts (ANC, WBC, platelet levels)
Tumor Growth Factor
Patients with cardiac/respiratory problems & hepatic or renal impairment
Adverse reactions in bone marrow transplant patients
First Dose Effect Filgrastim. Lexi-Drugs Online. Lexi-Comp.

Pegfilgrastim. Lexi-Drugs Online. Lexi-Comp.

Sargramostim. Lexi-Drugs Online. Lexi-Comp.

http://www.medhelp.org/drug_images/Amoxicillin-Clavulanate%20875%20mg-GG.jpg A 62 year old woman with stage 1 ovarian cancer has just received her 2nd round of chemotherapy ten days ago. She currently has a fever of 100.6 °F. Both her neutrophil & monocyte count are 100 cells/mm^2. Her hepatic and renal function tests are normal. Other than that, she looks fine with no other symptoms. Allergic reactions
Pain
Respiratory complications
Rupturing of spleen
Other rare but serious side effects picture found at: http://www.pharmactua.com/wp-content/uploads/neulasta1.jpg Hughes WT, Armstrong D, Bodey EJ, et al. 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases. 2003; 34:730-750.

Picture found at: http://www.drugs-health.com/blog/wp-content/uploads/2010/07/Ciprofloxacin-500-mg.jpg

Picture found at: http://www.medhelp.org/drug_images/Amoxicillin-Clavulanate%20875%20mg-GG.jpg
Full transcript