Pharmacist Renee McAllister discusses managing extravasation accidents, pharmacy operations, ideal body weight vs. AUC, giving G-CSF, and supportive care tips in hematology and oncology. They also emphasize the importance of staffing and safety checks in administering inpatient chemo, relying on primary sources for drug information, and the role of pharmacists in chemotherapy management.
GCSF support is essential for preventing febrile neutropenia during neutropenic chemotherapy.
Pharmacy operations for chemotherapy involve multiple pharmacists and technicians who verify doses, compound medications, and conduct quality checks.
Deep dives
GCSF Prophylaxis and Extravization Management
Febrile neutropenia risk determines the need for GCSF prophylaxis. NCCN guidelines provide recommendations based on the level of metagenicity. Extravization management is difficult to find information on, but institutional guidelines and drug monographs should be consulted.
Chemotherapy Order and Compounding Process
The timing of chemotherapy orders is determined by the availability of staff in the chemo pharmacy. The process involves multiple pharmacists and technicians, who verify the doses, compound the medication, and conduct quality checks. Cut-off times ensure adequate staffing. Certain drugs, like Melphalan, can be more difficult to compound. Once completed, the medication is sent for administration.
GCSF Support and Dosing
GCSF support is essential to prevent febrile neutropenia in patients undergoing neutropenic chemotherapy. The choice between short-acting or pegylated GCSF depends on factors such as cost, patient convenience, and safety. The on-body injector can automatically deliver pegylated GCSF after chemotherapy. Dosing varies based on the metagenicity and duration of neutropenic risk.
Anti-emetic Prophylaxis and Individualized Approaches
Anti-emetic prophylaxis is based on the likelihood of emesis associated with the chemotherapy regimen. High emetic risk regimens require three or four-drug regimens, including a 5-HT3 antagonist, dexamethasone, and aprepitant or olanzapine. Moderate emetic risk regimens may involve two or three drugs, and low emetic risk regimens typically require a single anti-emetic, such as Zofran.
In the final episode in our reboot of Pharmacology 101, we sit down with Renee McAlister, PharmD, BCOP to learn more about the nuances of pharmacology from an expert that does this day in and day out.
Content:
- How to manage extravasation accidents?
- Pharmacy operations
- What is "ideal body weight" vs. "AUC"
- Why do we give G-CSF
- Supportive care tips and tricks
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