9: Symptom Management Flashcards
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Can help with bowel movements. Correlation between constipation and nausea.
Anticholinergic
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Not usually used as single-modality approach. Very helpful for adjuvant therapy.
Dopamine 2 antagonist
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Specifically designed for chemotherapy-induced nausea and vomiting. May not work for disease-caused n/v or mass effect.
5-HT3 antagonist
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Zofran
5-HT3 antagonist
T/F Nausea is caused by the chemo treatment and not the cancer.
False. It can be caused by both. Bulky abdominal tumor pushing on stomach can cause nausea.
Pharm interventions for fatigue?
Psychostimulants (Ritalin, Adderall). May be necessary to educate patients about benefits, since used to treat ADD/ADHD. Helps with fatigue, appetite, concentration/focus (chemo brain).
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
N/V caused by liver capsule stretch.
Steroid or anti-inflammatory
Long or short acting opioid?
Oxycodone
Short
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Good for predosing before chemo.
Dopamine 2 antagonist
Sharp, knife-like pain is probably _____.
Neuropathic
Common symptoms during cancer treatment (3).
- Pain
- N/V
- Fatigue
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Reduces inflammation caused by cancer.
Steroids
Long or short acting opioid?
Fentanyl patches
Long
Is a short or long acting opioid tried first?
Short. Typically start with 5 mg oxycodone q4h PRN.
Long or short acting opioid?
MSIR
Short
What lifestyle changes can help with n/v (4)?
- Small, frequent meals.
- Consider food odor/fat content (pancreatic patients have reduced enzymes to break down fat).
- Cool, carbonated beverages.
- Takes meds after meals (except for anti-emetics).
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Less sedating than Zofran.
Dopamine 2 antagonist
Deep, aching pain is probably _____.
Visceral
_____ is closely linked to depression: less one does, less one wants to do.
Fatigue
10 mg IV morphine is = _____ oxycodone and _____ hydromorphone.
Morphine = 10 mg Oxycodone = N/A Hydromorphone = 1.5 mg
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Helps patient stay ahead of nause. Can be used several days after chemo.
Dopamine 2 antagonist
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Reglan
Anticholinergic
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Ativan
Benzo
Nonpharm interventions for fatigue (4).
- Cluster activities
- Make a schedule
- Take naps
- Schedule walks
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Can help with gastric motility.
Anticholinergic
Long or short acting opioid?
OxyContin
Long (contin = continuous)
What short-acting dose indicates need for long-acting opioid?
If patient requires 4-6 doses of oxycodone/day, consider long-acting opioid.
Long or short acting opioid?
Methadone
Long
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Can help with n/v from metastatic brain disease or brain cancer.
Steroids
30 mg PO morphine is = _____ oxycodone and _____ hydromorphone.
Morphine = 30 mg Oxycodone = 20 mg Hydromorphone = 7.5 mg
Name n/v etiologies (6).
V = Vestibular O = Obstruction M = Motility/Metabolic/Mass I = Inflammation/Infection T = Toxins (drugs/chemo) S = Stretch (liver, kidney capsule)
Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Compazine
Dopamine 2 antagonist
Long or short acting opioid?
Hydromorphone (Dilaudid)
Short
Long or short acting opioid?
MS Contin
Long (contin = continuous)
Why is a pain diary helpful?
Helps dose long-acting opioids if needed.