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therapeutics 2 drugs > Lec2 > Flashcards

Lec2 Flashcards

1
Q

Types of Chemotherapy induced Nausea and vomiting

A

1-Acute onset nausea and vomting(occurs within mins to hrs)
2-Delayed onset CINV (develops after more than 24 hrs)
3-Expected CINV (occurs before patient recieve their next treatment)
4-Breakthrough CINV(occurs despite prophylactic antiemesis treatment.
5-Refractory CINV (occurs despite rescue has benn intiated)

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2
Q

Delayed on set chemotherapy happens usually with what type of drugs with examples

A

happens commonly with Highly emetogenic chemotherapy,
ex (cisplatin, carboplating, cyclophosphamide, anthracyclines)

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3
Q

Managment of general conitions tha occur in cancer patients

CNS involvement

A

Dexamethasone, 4–8 mg PO BID-TID

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4
Q

Managment of general conitions tha occur in cancer patients

Gastric outlet obstructions

A

1-Dexamethasone PO.
2-Metoclopramide,30 min before meals and at bedtime.
3- PPI.

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5
Q

Managment of general conitions tha occur in cancer patients

Gastritis/GERD

A

PPI or H2 blocker

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6
Q

Managment of general conitions tha occur in cancer patients

Medication-induced gastropathy (gastritis)

A

PPI or metoclopramide

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7
Q

Managment of general conitions tha occur in cancer patients

Nonspecific NV

A

Metoclopramide or
(Hoop):
1-Ondansetron,
2-Haloperidol
3-Prochlorperazine,
4-Olanzapine

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8
Q

Managment of general conitions tha occur in cancer patients

Contributing anxiety

A

Lorazepam

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9
Q

Managment of general conitions tha occur in cancer patients

Vertiginous component

A

Anticholinergic AND/OR antihistamine

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10
Q

Pharmacologic consideration for antiemetic prescribing(prohylaxs mainly)

NK1 RAs

A

Largest benefit seen in a delayed CINV setting
ex(cisplatin, carboplatin, cyclophosphamide, and/or
anthracyclines)

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11
Q

Pharmacologic consideration for antiemetic prescribing(prohylaxs mainly)

5-HT3 RAs

A

Schedule dependant
non sedating
causes Headache and constipation

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12
Q

Pharmacologic consideration for antiemetic prescribing(prohylaxs mainly)

Corticosteroids

A

used mainly in extended delayed CINV
Ex(dexamethasone)
Consider AM dosing to minimize insomnia.

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13
Q

Pharmacologic consideration for antiemetic prescribing(prohylaxs mainly)

Olanzapine

A

bedtime administration is recommended when possible due to sedation

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14
Q

Pharmacologic consideration for antiemetic prescribing(prohylaxs mainly)

Benzodiazepines

A

Consider for anticipatory CINV or when breakthrough CINV has an
anxiety component

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15
Q

Pharmacologic consideration for antiemetic prescribing(prohylaxs mainly)

Phenothiazines

A

Promethazine is more sedating than prochlorperazine

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16
Q

Pharmacologic consideration for antiemetic prescribing(prohylaxs mainly)

Metoclopramide

A

Metoclopramide increases gut motility and can be utilized
to manage gastroparesis

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17
Q

Pharmacologic consideration for antiemetic prescribing(prohylaxs mainly)

Haloperidol

A

lower doses of haloperidol are required to
produce an antiemetic effect than what is required for an
antipsychotic effect

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18
Q

Pharmacologic consideration for antiemetic prescribing(prohylaxs mainly)

Scopolamine

A

Consider using when positional changes, movement,
or excessive secretions are triggering episodes of
nausea/vomiting

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19
Q

Pharmacologic consideration for antiemetic prescribing(prohylaxs mainly)

Cannabinoid

A

May stimulate appetite

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20
Q

Emetogenecity risks of cancer agents

A

1-Minimal emetic risk(<10%)
2- Low emetic risk (10%-30%)
3-Moderate emetic risk (>30%–90%)
4-High emetic risk>90%

if it says <30% without spicifying means low to minimal

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21
Q

anti emetic prevention agents for Low risk anticancer

A

D+PMS:
1- Dexamethasone
2- Metoclopramide
3-Prochlorperazine
4-5-HT3 RA:–GOD:(-Granisetron,-Ondansetron,-Dolasetron.)

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22
Q

anti emetic prevention agents for minimal risk anticancer

A

None needed ;)

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23
Q

anti emetic prevention for Low to minimal risk

A

1-Metoclopramide
2- Prochlorperazine
3-5-HT3 RA:–GOD:(-Granisetron,-Ondansetron,-Dolasetron.)

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24
Q

anti emetic prevention for moderate emetic risk

A

takes two drugs on Day1:
1-5-HT3 RA:–GOD+P:(-Granisetron,-Ondansetron,-Dolasetron, Palonosetron)..
and 2-Dexamethasone
day 2-3 continue on only one of them

Granisetron is preferred

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25
Q

anti emetic prevention for high emetic risk

A

takes 4 drugs on day 1:
1- Olanzapine
2-NK1 receptor antagonist( Aprepitant, Netupitant, Fosnetupitant )
3-5-HT3 RA:–GOD+P:(-Granisetron,-Ondansetron,-Dolasetron, Palonosetron)
4- Dexamethasone 12mg
Day2-4 takes 3 drugs:
1- Olanzapine
2-Aprepitant
3- Dexamethasone 8 mgs

if he didnt take aprepitant then on Days 2-4 only takes two drugs

(Netupitant, Fosnetupitant) are the only ones that comes in combination.

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26
Q

Breakthrough treatment for anticancer therapy-induced nausea/vomiting

A

1-Olanzapine (preferred catagory) (1)
2- Lorazepam (only when patient has anxiety)
3-Cannabinoid (Dronabinol ,Nabilone)
4- Other:(HMS): Haloperidonl,Metoclopramide, Scopolamine
5-Phenothiazine: Prochlorperazine, Promethazine
6-5-HT3 RA:–GOD+P:(-Granisetron,-Ondansetron,-Dolasetron, Palonosetron)
7-Corticosteroid: Dexamethasone

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27
Q

treatment for Radiation-induced nausea/vomiting

A

1-Granisetron w/wo Dexamethasone
2-Ondansetron w/wo Dexamethasone

Start before radiation therapy

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28
Q

treatment for Anticipatory nausea/vomiting

A

A/prevention mainly: 1-optimize antiemetic therapy
2-avoid strong smells
B/Behavioral therapy.
C/ Consider anxiolytic therapy (Lorazepam the night before)

29
Q

Pain rating Scale

A

None(0)
Mild(1-3)
Moderate(4-6)
Severe(7-10)

30
Q

Mild pain treatment for naive and opioid tolerant patients

A

1-First consider non opioid adjuvant therapies
2-Re-evaluate need for opioids and reduce if appropriate

31
Q

Moderate/Severe Pain - Opioid-naïve patients

A

Non-opioids and adjuvant therapies as appropriate with one short acting opioid as needed:
1-Oxycodone immediate release w/wo acetaminophen or
2-Hydrocodone with acetaminophen or
3-Hydromorphone or
4-Morphine or

if patient takes opioid therapy more than 4 times a day consider long acting opioid

32
Q

Moderate/Severe Pain - Opioid tolerant patients

A

Non-opioids and adjuvant therapies as appropriate with short-acting
opioids as needed:
Dose may require a 30%-50% increase compared to naive patient

33
Q

Severe Pain/Pain Crisis or uncontrolled pain naive vs tolerant, IV vs Oral

A

IV:Opioid-naïve patients: 2-5mg IV morphine sulfate
Opioid-tolerant patients: Administer IV opioid dose equivalent to 10%–20% of the total opioid taken in the previous 24 h
reassess after 15min

Oral:Opioid-naïve patients: 5–15 mg oral short-acting morphine sulfate
Opioid-tolerant patients:Administer oral opioid dose equivalent to 10%–20% of total opioid taken in the previous 24 h
reassess after 60min

34
Q

Acetaminophen daily max dose

A

4G/day

3G/day in chronic use

35
Q

Which NSAID to use

A

Use any NSAID but consider ibuprofen to maximal dose

36
Q

Antidepressants used along side opioid for pain

A

the more efficacious: (amitriptyline, imipramine)
the better tolerated: (nortriptyline, desipramine)

37
Q

Drugs use in Chemotherapy induced peripheral neuropathy

A

1-Duloxetine
2-Venlafaxine

38
Q

example of Anticonvulsants as Adjuvant analgesics for neuropathic pain

A

Gabapentin & Pregabalin

1-Pregabalin is more efficiently absorbed through the GI tract than gabapentin,
2-Dose adjustment is required for those with renal insufficiency

39
Q

example of Topical Agents used with analgesics for neuropathic pain

A

Lidocaine patch

causes cutaneous damage over time with use

40
Q

example of Corticosteroids use as Adjuvant analgesics for neuropathic pain

A

(dexamethasone)
Useful in the acute management of a pain crisis when neural structures or bones are involved.

preferably in the morning,

41
Q

example of drugs that are not recommended in pain mangement

A

1-Meperidine
2-Mixed agonist-antagonists (pentazocine, nalbuphine, butorphanol)

42
Q

Pallative care for Dyspnea for both dying and not dying patient

general

A

opioid

consider alternative in non dying patient if renal insuffiency

43
Q

Pallative care for Dyspnea for both dying and not dying patient

Anxiety

A

Lorazepam

44
Q

Pallative care for Dyspnea for both dying and not dying patient

Fluid overload

A

furosemide

45
Q

palliative care -Anorexia/Cachexia non dying patient

Depression/anorexia

A

Mirtazapine

46
Q

palliative care -Anorexia/Cachexia non dying patient

Gastroparesis

A

Metoclopramide

before meals and at bed time

47
Q

palliative care -Anorexia/Cachexia non dying patient

Low/no appetite

A

Olanzapine

48
Q

palliative care -Anorexia/Cachexia dying patient

Low/no appetite

A

DOC:1-Dexamethasone
2- Olanzapine
3- cannabinoid

49
Q

constipation prophylaxis

A

senna+ polyethylene glycol

recommend starting with polyethylene glycol if the patient is not on opioids

50
Q

General constipation treatment

A

bisacodyl oral
with a goal of 1 non-forced bowel
movement (BM) every 1–2 days

51
Q

Persistent constipation treatment

A

(BPCSS)
1- Bisacodyl suppository
2-Polyethylene glycol
3- LaCtulose
4-Sorbitol
5-magneSium hydroxide

52
Q

Opioid-induced constipation treatment

A

NLM:
1-Methylnaltrexone
2-Linaclotide
3-Naloxegol

53
Q

* palliative care Diarrhea non dying patient

Grade 1 diarrhea treatment

A

if on opioid: Loperamide (preferred)
If not on opioids: – Diphenoxylate/atropine

54
Q

* palliative care Diarrhea non dying patient

Grade 2 diarrhea treatment

A

if on opioid Initiate/continue loperamide
If not on opioids: Diphenoxylate/atropine or hyoscyamine or atropine

55
Q

* palliative care Diarrhea non dying patient

C. diff-induced diarrhea treatment

A

1-Metronidazole
2-Vancomycin

56
Q

* palliative care Diarrhea non dying patient

Immunotherapy-related diarrhea treatment

A

1-Dexamethasone
2-infliximab

57
Q

* palliative care Diarrhea non dying patient

Grades 3/4 (Inpatient hospitalization w/ICU for Grade 4) diarrhea managment

A

if not on opioid: Initiate/continue loperamide
If not on opioids: Diphenoxylate/atropine or hyoscyamine or atropine
(Consider octreotide)

58
Q

* palliative care Diarrhea dying patient

Dying patient diarrhea managment

A

Reevaluate ongoing antidiarrheal, anticholinergic agents
Initiate or increase dose of around-the-clock opioid
AGO: Atropine, or glycopyrrolate, or octreotide.

59
Q

palliative care – Malignant Bowel Obstruction treatment

A

1- Reduce opioid dose or rotate opioid
2-Metoclopramide
3-Dexamethasone
4- Octreotide
5-anticholenergic:Scopolamine, hyoscyamine,glycopyrrolate

avoid Metoclopramide in the setting of complete obstruction
discontinue Dexamethasone if no improvement in 3–5
days
if prognosis >8 weeks consider long acting injection

60
Q

palliative care for – Sleep/Wake Disturbance

Insomnia treatment

A

(TOZ MLCQ)
* Trazodone
* Olanzapine
* Zolpidem
* Mirtazapine
* Lorazepam
* Chlorpromazine
* Quetiapine

61
Q

palliative care for – Sleep/Wake Disturbance

phase shift disorder treatment

A

1-ramelteon
2-melatonin

62
Q

palliative care for – Sleep/Wake Disturbance

Daytime Sedation treatment

A

CDMM:
1-Caffeine
2- Dextroamphetamine
3-Methylphenidate
4-Modafinil

63
Q

palliative care for – Sleep/Wake Disturbance

restless leg syndrome

A

1- Ropinirole
2-Pramipexole

64
Q

palliative care – Delirium non dying patient

Mild/Moderate Delirium treatment

A

1- Haloperidol (preferred)
2-Risperidone
3- olanzapine
4-quetiapine

65
Q

palliative care – Delirium non dying patient

Severe Delirium (agitation) treatment

A

1-Haloperidol
2-Olanzapine
3-chlorpromazine

66
Q

palliative care – Delirium non dying patient

High-dose neuroleptic-refractory treatment

A

lorazepam

67
Q

palliative care – Delirium dying patient

delirium for dying patient

A

Upward titrate haloperidol, risperidone, olanzapine

68
Q

palliative care – Delirium dying patient

High-dose neuroleptic-refractory

A

Upward titrate lorazepam
* Consider rectal or IV haloperidol

69
Q

Palliative Sedation

Imminently dying patient pallative care

A

1-Benzodiazepines:Midazolam or lorazepam.
2- Phenobarbital or pentobarbital
3-propofol.

therapeutics 2 drugs (9 decks)

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