BCPS / Oncology

Pharmacy Question Bank / BCPS / Oncology

BCPS

The questions in this section are intended to test your knowledge and skills on pharmacotherapy including biostatistics for practicing pharmacists and pharmacist preparing for BCPS (Board Certified Pharmacotherapy Specialist)
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BCPS | Oncology

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Question 1
SR is a 72 year old female admitted to ICU with PNA, A Fib, CHF with preserved left ventricular function. She weighs 76 kg. She has history of lung cancer for which she is being treated with cyberknife and chemotherapy as outpatient, history of hypertension, hyperlipidemia, hypothyroidism, COPD. On admission her WBC is 1.0 K/uL, bands of 32% and segs of 42%. SR was started on Vancomycin, Levofloxacin and Aztreonam for HAP. She is also on the electrolyte replacement protocol. She is allergic to PCN/cephalosporin (rash). For her A. Fib she was given Amiodarone 400mg orally BID and Diltiazem 10mg/hr. She also received few doses of furosemide for her CHF. What is SR’s ANC?
A
740
B
500
C
420
D
320
Question 1 Explanation: 
ANC = WBC * ((Segs/100) + (Bands/100)) ANC = 1.0 k/uL x (0.32 + 0.42) = 740 Reference: Whalen KL, Borja-Hart N (2015). Interpretation of Clinical Laboratory Data. In: Nemire RE, Kier KL, Assa-Eley M. Nemire R.E., Kier K.L., Assa-Eley M Eds. Ruth E. Nemire, et al.eds. Pharmacy Student Survival Guide, 3e. New York, NY: McGraw-Hill; 2015.
Question 2
SR is a 72 year old female admitted to ICU with PNA, A Fib, CHF with preserved left ventricular function. She weighs 76 kg. She has history of lung cancer for which she is being treated with cyberknife and chemotherapy as outpatient, history of hypertension, hyperlipidemia, hypothyroidism, COPD. On admission her WBC is 1.0 K/uL, bands of 32% and segs of 42%. SR was started on Vancomycin, Levofloxacin and Aztreonam for HAP. She is also on the electrolyte replacement protocol. She is allergic to PCN/cephalosporin (rash). For her A. Fib she was given Amiodarone 400mg orally BID and Diltiazem 10mg/hr. She also received few doses of furosemide for her CHF. Physician would like to treat SR’s low ANC. Which of the following would be the treatment of choice with dose for her low ANC?
A
Filgrastim 380 mcg subcutaneously daily
B
Filgrastim 480 mcg subcutaneously daily
C
Erythropoietin 10,000 untis subcutaneously daily
D
Fresh Frozen Plasma (FFP) 15 mls/kg
Question 2 Explanation: 
Considering this patient had received chemotherapy (unable to determine when exactly), this dosage is consistent with the indication of primary prophylaxis in patients with nonmyeloid malignancies (5 mcg/kg/day subcutaneously). Erythropoietin is indicated for treatment of Anemia due to various causes. FFP is given in certain bleeding disorder to replace factors. Reference: 1) Smith TJ, Khatcheressian J, Lyman GH, et al. 2006 Update of recommendations for the use of white blood cell growth factors: an evidence-based clini¬cal practice guideline. J Clin Oncol 2006;24:1-19.
2) Gold Standard, Inc. Filgrastim, G-CS. Clinical Pharmacology [database online]. Available at: https://www.clinicalpharmacology-ip.com/Forms/Monograph/monograph.aspx?cpnum=246&sec=monindi&t=0 Accessed: May 16, 2016.
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