Supportive Care Flashcards

Question

Irinotecan- induced diarrhea

Answer 1

irinotecan can cause acute or delayed diarrhea acute: -due to cholinergic stimulation -mean duration ~30mind -usually respond rapidly to atropine delayed: -due to GI mucosal damage secondary to SN-38 -usually occurs >24 hours after admin -noncumulative and occurs at all dose levels

Answer 2

Nonpharm: -avoidance of foods that aggravate diarrhea -aggressive oral rehydration with fluids that contain water, salt, and sugar Pharm: -loperamide: first line, 4mg followed by 2mg q 4hours or after every unformed stool (max 16mg) -diphenoxylate-atropine: 1-2 tabs q 6hours until control achieved (max 8 tabs)

Answer 3

octreotide tincture of opium probiotics rule out clostridiolides difficile and infection colitis

Answer 4

occurs in 20-40% of patients Onset: 5-14 days Complications: decreased oral intake: poor nutritional status Grade 3-severe oral pain Grade 4- requires parenteral or enteral nutrition Infection Risk: gram positive oral flora, candida or fungal infections Pain: may require opioids and PCA admin

Answer 5

erythematous and ulcerative lesions of the mucosa observed in patients treated with chemo can occur anywhere in the GI tract

Answer 6

mucositis limited to the oral cavity

Answer 7

initiation: cellular damage induces, reactive oxygen species formation primary damage response: activation of p53 & NF-kB signal amplification: release of inflammatory cytokines, tissue damage and cell death ulceration: high risk for bacterial colonization healing: cessation from ongoing tissue damage

Answer 8

melphalan cisplatin + radiation high dose methotraxate doxorubicin busulfan 5-FU

Answer 9

smoking poor oral hygiene oral lesions at baseline female sex pretreatment nutritional status

Answer 10

asymptomatic or mild symptoms intervention not indicated

Answer 11

moderate pain or ulcer that does not interfere with oral intake modified diet indicated

Answer 12

severe pain interfering with oral intake

Answer 13

life threatening consequences urgent intervention indicated

Answer 14

oral hygiene cryotherapy

Answer 15

oral decontamination: bland or oncology mouthwash, dexamethasone for everlimus-induced pain control: 2% lidocaine, systemic opioids palliation of dry mouth: artificial saliva products or chewing gum nutritional support: liquid or soft diet; TPN oral candidiasis treatment: fluconazole 200mg x1, then 100mg x 21 days

Answer 16

prior chemotherapy or radiation therapy persistent neutropenia bone marrow involvement by tumor recent surgery and/or open wounds liver dysfunction renal dysfunction >65 yo full dose chemo

Answer 17

short acting GCSF start next day or up to 3-4 days after completion of chemo (5mcg/kg) given until ANC recovery

Answer 18

long acting GCSF can admin day after or up to 3-4 days after completion of chemo single admin(6mg) allow >12 days between dose of pegfilgrastim and next cycle of chemo

Answer 19

long acting GCSF admin 24 hours after chemo single admin do not administer 14 days before and within 24 hours of chemo

Answer 20

sepsis syndrome >65 yo ANC <100 neutropenia expected to be >10 days in duration pneumonia or other clinically documented infections invasive fungal infection hospitalization at time of fever prior episode of febrile neutropenia

Answer 21

tumor invades bone, muscle, or connective tissue often presented as aching, stabbing, throbbing or pressure

Answer 22

tumor invades internal organs and blood vessels often presented as gnawing, cramping, aching, or sharp pain

Answer 23

pain sustained by damage or dysfunction in the nervous system often presented as burning tingling shooting or electric/shocking pain

Answer 24

offer to patients with moderate to severe pain lowest possible dose to achieve acceptable analgesia start with immediate release and PRN with frequent assessment and titration PRN -breakthrough pain -IR or short acting opioid Around the clock -treat chronic pain -SR or long acting opioids

Answer 25

increased immune system activity from ICI results in inflammatory side effects -increased t cell activity, preexisting autoantibodies, inflammatory cytokines can occure during or after discontinuation on ICI treatment make note of history of autoimmune disease

Answer 26

symptomatic management local therapies preferred consider delaying immunotherapy corticosteroids may be required

Answer 27

hold immunotherapy corticosteroids required possible additional immunosuppressant in steroid refractory AEs inpatient managemnet and addition supportive care may be necessary

Answer 28

dose varies based on severity -prednisone 0.5-2mg/kg/day -methylprednisolone 1-2 mg/kg/day prolonged steroid taper (4-12 weeks) may be required long term use associated with HTN, osteoporosis, weight gain, insomnia, mental status changes, metabolic dysfunction, increased infection risk

Answer 29

Gastritis: -PPI or H2 blocker in high risk (NSAID use, anticoagulation) for duration of corticosteroids Infection -PJP prophy: prednisone equivilant >20mg for >4 weeks : trimethoprim/sulfamethoxazole preferred -Fungal: prednisone equivalent >20mg for 6-8 weeks : fluconazole Osteoporosis -Vit D 400-1000 IU daily and calcium 1000-1200mg from food or supplementation