Case 1: 12 year old boy with X-linked agammaglobinemia. Ordered IVIG 400 mg/kg every 4 weeks. weight: 30kg. How much IVIG (grams) is needed for this patient?

• 3g

• 12g

• 30g

• 40g

Case 1: 12 year old boy with X-linked agammaglobinemia. Ordered IVIG 400 mg/kg every 4 weeks. weight: 30kg. How would you titrate the infusion rate?

• Begin at max rate immediately

• start 5 mg/kg/min, increase every 5 minutes

• start 0.5-1 mg/kg/min, increase every 15-30 minutes

• no titration needed

Case 1: 12 year old boy with X-linked agammaglobinemia. Ordered IVIG 400 mg/kg every 4 weeks. weight: 30kg. Which baseline assessment is most important?

• thyroid function

• cholesterol panel

• pulmonary function

• IgA deficiency and renal function

Case 2: 45 year old woman with Guillain-Barre Syndrome. Ordered: IVIG 2g/kg total dose, divided over 5 days. Weight: 70kg. What is the total dose (g) and daily dose?

• 140 g total → 28 g/day

• 70 g total → 14 g/day

• 100 g total → 20 g/day

• 280 g total → 56 g/day

Case 2: 45 year old woman with Guillain-Barre Syndrome. Ordered: IVIG 2g/kg total dose, divided over 5 days. Weight: 70kg. What adverse reactions are common?

• Alopecia

• Headache, fever, chills

• Constipation

• Myocardial Infarction only

Case 2: 45 year old woman with Guillain-Barre Syndrome. Ordered: IVIG 2g/kg total dose, divided over 5 days. Weight: 70kg. What interventions should be in place if she develops headache + fever during infusion?

• Continue at same rate and monitor

• stop infusion permanently and switch to a different medication

• Slow/stop infusion, give acetaminophen/antihistamines, notify provider

• add 500 mL NS bolus and continue at faster rate

Case 3: 72 YO man with chronic lymphocytic leukemia, baseline CrCl of 35 mL/min. Ordered: IVIG 1g/kg x 2 days. Weight: 80kg. What precautions should you take regarding infusion rate and product choice?

• Infuse at slower rates, avoid sucrose containing products

• Use sucrose-containing IVIG at high rate

• skip premedication

• use albumin instead

Case 3: 72 YO man with chronic lymphocytic leukemia, baseline CrCl of 35 mL/min. Ordered: IVIG 1g/kg x 2 days. Weight: 80kg. Which adverse effects are especially concerning in this patient?

• Rash and itching only

• hearing loss

• diarrhea

• acute renal failure and thrombosis

Case 3: 72 YO man with chronic lymphocytic leukemia, baseline CrCl of 35 mL/min. Ordered: IVIG 1g/kg x 2 days. Weight: 80kg. How would you monitor renal function during therapy?

• Daily chest x-rays

• Ophthalmology exam

• Urine output, serum creatinine, hydration status

• EKG monitoring

Case 4: 30 year old woman receiving IVIG for myasthenia gravis. Event: 30 minutes into infusion, develops flushing, chills, and chest tightness. What is your first nursing action?

• stop or slow infusion

• increase infusion rate

• Administer more IVIG

• Ignore unless BP drops