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Cancer Therapies And NIS Pharmacotherapies > NIS Management > Flashcards

NIS Management Flashcards

1
Q

Potential outcomes of anorexia and early satiety

A

Inadequate energy intake, unintentional weight loss, sarcopenia, nutrient insufficiency and deficiency, dehydration, and malnutrition

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2
Q

Anorexia Grade 1

A

Loss of appetite without alteration in eating habits

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3
Q

Anorexia Grade 2

A

Oral intake altered without significant wight loss or malnutrition; oral nutritional supplements indicated

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4
Q

Anorexia Grade 3

A

Associated with significant weight loss or malnutrition; tube feeding or PN indicated

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5
Q

Anorexia Grade 4

A

Life-threatening consequences; urgent intervention indicated

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6
Q

Grade 5

A

Death

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7
Q

MNT for anorexia

A

Small, frequent meals (6-8); eat by the clock; maximize intake when appetite is best; use ONS; consume liquids between meals; enhance nutrient density, if tolerated; use easily prepared foods; keep convenience foods on hand; engage in light physical activity

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8
Q

Pharmacotherapy for anorexia

A 
Antihistamines (Periactin) in children
Corticosteroids (Dexamethasone)
Progestational agents (Provera, Megace)
Prokinetic agents (Reglan)
Cannabinoids (Marinol, Syndros, Casamet)
Antidepressants (Remeron)
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9
Q

Potential outcomes of dysgeusia

A

Decreased intake
Nutrient insufficiency and deficiency
Unintentional weight loss

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10
Q

Dysgeusia Grade 1

A

Altered taste, no change in diet

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11
Q

Dysgeusia Grade 2

A

Altered taste with change in diet; noxious or unpleasant taste; loss of taste

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12
Q

Constipation pharmacotherapy

A 
Insoluble food fiber
Medicinal fibers
Stool softener
Lubricants
Osmotic laxatives
Stimulant laxative agents
Opioid antagonist
Herbals
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13
Q

Insoluble food fiber

A

Bran, flaxseed, wheat germ, inulin

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14
Q

Medicinal fibers

A 
Psyllium (Metamucil)
Wheat dextrin (Benefiber)
Carboxymethylcellulose (Trulance)
Methylcellulose (Citrucel)
Polycarbophil (FiberCon)
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15
Q

Stool softener

A

Ducosate (Colace, Surfak)

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16
Q

Lubricants

A

Mineral oil

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17
Q

Osmotic Laxatives

A

MiraLAX (polyethylene glycol)
Lactulose (Duphalac, Cadilose)
Magnesium hydroxide (Milk of Magnesia)
Magnesium citrate

18
Q

Stimulant Laxative Agents

A

Bisacodyl (Dulcolax, Correctol, Carter’s pills)

Sennosides (Senokot, Ex-lax)

19
Q

Opioid Antagonist

A

Relistor
Amitiza
Morantik
Symproic

20
Q

Herbals

A

Probiotics, slippery elm, aloe juice, cascara sagrada

Caution: Bacteremia is possible in immunocompromised patients. Avoid opening capsules of probiotics is port is present

21
Q

Fluid needs for constipation

A

64-80 oz daily (8-10c)

Additional 32 oz if using medicinal fibers

22
Q

Fiber needs for constipation

A

Women: 25 g/d
Men: 38 g/d

Increase slowly as tolerated

23
Q

Medications that may slow gastric emptying

A 
Vinca alkaloids
opioids 
aluminum hydroxide antacids
histamine H2-recepter antagonists
PPI
sucralfate
interferon
levodopa
sedatives
antiemetics
24
Q

Potential outcomes of diarrhea

A

Frequent stools, dehydration, electrolyte imbalances, unintentional weight loss, fatigue, nutrient insufficiency and deficiency, malnutrition, skin irritation

25
Q

Treatments or medications that cause diarrhea

A 
Chemo: Irinotecan, VP-16 (etoposide)
RT to pelvis
Antibiotics
Prokinetic agents
Stool softeners, laxatives
Dietary causes (EtOH, caffeine, sugar alcohols, lactose, high insoluble fiber intake)
26
Q

Fluid needs for diarrhea

A

64-80 oz (8-10c) daily

Additional 1c for each loose BM

27
Q

Pharmacotherapy for diarrhea

A

Opioid receptor antagonists: Imodium AD (Loperamide), Lomotil
Hormonal: Sandostatin (ocreotide)
Opioids: Paregoric, camphorated tincture of opium
Anti-inflammatory, anti-diarrheal: Pepto-Bismol, Kaopectate
Bile acid sequestrant: Cholestyramine (Questran)
Anticholinergics: diphenhydramine (Benadryl)
Medicinal Fibers: psyllium (Metamucil), psyllium or calcium polycarbophil caplets (Konsyl); methylcellulose (Citracel)
Preventative for gut radiotherapy: amifostine (Ethyol)
Amino acids: L-glutamine (reduces duration, not severity); Enterade (blend of AA)
Probiotics: saccharomyces boulardii, Lactobacillus rhamnosus GG

28
Q

Potential outcomes for dysphagia

A

Coughing, choking, feeling of “food getting stuck”, odynophagia, aspiration, pneumonia, weight loss, nutrient insufficiencies and deficiencies, dehydration, malnutrition

29
Q

Thickeners

A

Simply Thick gel, Thicken Right, Thicken up; Thick & Easy, Thick It

30
Q

Topical anesthetics for dysphagia

A

Lidocaine spray (Xylocaine)

31
Q

Fatigue pharmacotherapy

A

Blood transfusions

Erythropoietin given as epoetin alfa

32
Q

Potential outcomes for malabsorption

A

Abnormal digestive enzyme studies, steatorrhea, unintentional weight loss, dehydration, nutrient insufficiency and deficiency, malnutrition, fatigue

33
Q

PERT dosing per g fat

A

500-1000 U lipase /g fat

Do not exceed 4000 u lipase/g fat

34
Q

PERT dosing per kg

A

Do not exceed 2500 u lipase/kg/meal or 10,000 u lipase /kg /day

start 500 u lipase /kg /meal, increase as tolerated
250 u lipase/kg/snack

35
Q

PER dosing per meal

A

20,000-75,000 lipase/meal and 5,000-50,000 u lipase/snack

36
Q

PERT Considerations

A

Some PERT require concurrent PPI to maintain effectiveness.
Do not sprinkle or mix contents of capsules on diary products or consume foods with a pH >4. Sprinkle on applesauce immediately before eating a meal, if needed.

37
Q

Potential outcomes for N/V

A

Dehydration, electrolyte and acid-base imbalance, nutrient insufficiency and deficiency, unintentional weight loss, aspiration, esophagitis, Mallory-Weiss syndrome, fractures, wound dehiscence, and potential withdrawal from antineoplastic treatment

38
Q

Pharmacotherapy for acute N/V

A 
Serotonin antagonists (5-HT3 receptor antagonists:
Ondansetron (Zofran)
Dolasetron (Anzemet)
Granisetron (Kytril)
Palonosetron (Aloxi)
Tropisetron (Navoban)
39
Q

Pharmacotherapy for Delayed N/V

A 
Dopamine antagonists (Phenothiazines):
prochlorperazine (Compazine), promethazine (Phenergan)

Nerokinin-1 (NK-1) receptor antagonists:
aprepitant or fosaprepitant (Emend)
netupitant / palonsetron (Akynzeo)
Rolapitant (Varubi)

40
Q

Etiology of N/V

A 
Anticipatory (prior to chemo)
Acute (24 hours after chemo)
Delayed (1-7 days after chemo)
Breakthrough (occurs despite prophylactic medications, requiring "rescue" medications)
Refractory (all medications failed)
41
Q

Pharmacotherapy for N/V

A

Benzamides: Reglan
Cannabinoids: Marinol, Syndros, Cesamet
Benzodiazapines: Ativan Valium
Corticosteroids: Dexamethasone, prednisone

42
Q

Complementary therapies for N/V

A

Ginger tea, ginger ale, 0.5-1.0 g ginger extract, acupressure bracelets, acupuncture, massage, transcutaneous electrical nerve stimulation, relaxation techniques, self-hypnosis

Cancer Therapies And NIS Pharmacotherapies (3 decks)

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