oncologic emergencies and GI toxicity Flashcards
4 types of cancer induced nausea and vomiting
anticipatory
acute
delayed
breakthrough/refractory
risk factors for CINV
- female
- younger
- poor emetic control in previous cycles
- Hx of motion sickness
- Hx of morning sickness
ondansetron MoA
inhibits serotonin receptors
ondansetron adverse effects
headache
constipation
diarrhea
QT prolongation
ondansetron phase use
acute
delayed
aprepitant MoA
inhibit NK1 receptors
apreptiant adverse effects
fatigue
dizziness
diarrhea
apreptiant phase use
acute
delayed
phenothiazine drugs
prochlorperazine
promethazine
phenothiazines MoA
inhibit D2 receptors
phenothiazines adverse effects
CNS depression
anticholinergic
extrapyramidal symptoms
hypotension
benzamide drug
metoclopramide
metoclopramide MoA
inhibit D2 and serotonin
metoclopramide adverse effects
sedation
diarrhea
EPS
QT prolongation
metoclopramide phase use
breakthrough/refractory
phenothiazine phase use
acute
delayed
breakthrough
atypical antipsychotic for N/V
olanzapine
olanzapine MoA
inhibit dopamine and serotonin
olanzapine adverse effects
somnolence
dry mouth
dizziness
QT prolongation
olanzapine phase use
acute
delayed
refractory
corticosteroid of choice for NV
dexamethasone
dexamethasone phase use
acute
delayed
benzodiazepine of choice for NV
lorazepam
lorazepam phase use
anticipatory
breakthrough
cannabinoids phase use
breakthrough/refractory
cannabinoids adverse effects
anticholinergic
sedation
appetite stimulation
hallucinations
general prophylaxis treatment for high risk NV
5HT3 + dexameth + aprepitant +- olanzapine
general prophylaxis treatment for moderate risk NV
5HT3 + dexameth +- aprepitant
general prophylaxis treatment for low risk NV
5HT3 or steroid or phenothiazone
treatment for mucositis
- mouthwash and coating agents
- analgesics
- corticosteroids
treatment of diarrhea
- hydration
- BRAT diet and clear liquids
- loperamide, octreotide
treatment of constipation
- stop nonessential meds
- increase fluids
- any laxitive
signs and symptoms of hypercalcemia
- fatigue and altered mental status
- AKI
- NV, anorexia, PUD
- short QT, ventricular arrhythmia
Risk factors for tumor lysis syndrome
- highly proliferative
- malignancies
- high treatment sensitivity
- renal dysfunction
management of spinal cord compression
- dexamethasone 10-100 mg bolus, 4-8 q6h
- spinal radiation
- surgery
- chemo
- pain management