Supportive Care: CTID

Question 1

Risk factors of CTID

Answer 1

Fever, orthostatic symptoms, abdominal pain/cramping, weakness

Question 2

Diarrhea grading: grade 1

Answer 2

Increase in <4 stools/day over baseline

Question 3

Diarrhea grading: grade 2

Answer 3

Increase of 4-6 stools/day over baseline

Question 4

Diarrhea grading: grade 3

Answer 4

Increase of ≥7 stools/day over baseline

Question 5

Diarrhea grading: grade 4

Answer 5

life-threatening consequences, urgent intervention needed

Question 6

Irinotecan-induced diarrhea treatment: acute

Answer 6

Atropine (due to cholinergic stimulation, lasts on average 30 minutes)

Question 7

Irinotecan-induced diarrhea features

Answer 7

GI mucosal damage secondary to SN-38, usually occurs more than 24hrs after administration

Noncumulative and occurs at all dose levels

Question 8

Nonpharm management of CTID

Answer 8

Avoidance of triggers (like food), aggressive PO rehydration with fluids that contain salt, water, sugar

Question 9

Pharm management of CTID: first-line

Answer 9

Loperamide

4mg followed by 2mg q4h or after every unformed stool (MDD: 16mg/day)

Question 10

Pharm management of CITD: second-line

Answer 10

Diphenoxylate-atropine

1-2 tabs q6h until control achieved (MDD: 8 tabs)