Supportive Care

Question 1

High emetic risk regimens IV

Answer 1

• Day 1 Olanzapine, Dexa, NKI (-pitant) and 5HT3 (-sterone). Day 2-4 Olanza and Dexa (+ aprepitant PO if used on day one)
• day 1: olanz, dex, palonsetron ; day 2-4: olanza
• day 1: dexa, NKI, 5HT3 day 2-4 Dexa and aprep id used

Question 2

Mod emetic risk preferred regimen IV

Answer 2

• day 1: dexa + 5ht3 ra, day 2-3: dexa or 5ht3
• option 2 same as high
• Day 1: dexa, NKI, 5HT3; Day 2-3 Aprep PO if used +/- dexa

Question 3

only po class for emetic risk

Answer 3

5HT3 RA- ondasteron, Graniseteron (1st gen- short acting ), palonsetron (2nd gen- long acting)
*QTC prolong

Question 4

options for break through induced n/v

Answer 4

• breakthrough occurs despite prophylaxis
• olanzapine, benzo, scopalmine

Question 5

option for anticipatory n/v

Answer 5

lorazepam

Question 6

options for prevention of n/v

Answer 6

Olanzapine, NKI (-pitant)

Question 7

patient risk factors for mucositis

Answer 7

smoking
poor oral hygiene
oral lesions @baseline
female sex
pretreatment nutritional

Question 8

prevention for mucositis

Answer 8

• oral hygiene
• switch from tabs to IV
• cryotherapy (hold ice chips in mouth)

Question 9

manage mucositis

Answer 9

• oral decontamination→ dexamethasone mouth wash
• pain control → 2% lido wash, systemic opioids
• palliation of dry mouth → artificial saliva, chewing gum
• nutritional support
• ora candidas → fluconazole

Question 10

Treatment for febrile neutropenia

Answer 10

• did the pt receive filgrastim (short acting) prophylaxis → yes→ continue it
• Recieved long acting agents prophylaxis→ no additional needed
• no prophylaxis with G-CSFs - assess risk

Question 11

treatment for induced diarrhea

Answer 11

1st line : loperamide
2nd : atropine

Question 12

treatment for refractory induced diarrhea

Answer 12

octreotide
tincture of opium
probiotics
*rule out c diff