Symptom Management Flashcards
Difference between sarcopenia and cachexia?
Sarcopenia is AGE related loss of muscle mass and strength
Cachexia is ILLNESS related loss of skeletal muscle mass and weight
3 main differences for cachexia-
1) INCREASED basal metabolic rate
2) INCREASED inflammation
3) INCREASED muscle degradation
(not true in sarcopenia)
Definition of cachexia?
1) Weight loss > 5% over past 6 months
2) Weight loss >2% in patients already having BMI <20 or with skeletal muscle mass
Is associated with increased mortality, decline and poor QOL
Cachexia more common in what malignancies? Less common in what 2 malignancies?
1) More common in GI, pancreatic, lung, colorectal cancers
2) Less common in breast and prostate cancers
Impact of cancer cachexia?
1) Decreased physical functioning
2) Decreased independence (increasing help needed with ADLs)
3) Increased risk of hospitalizations
4) Decreased response to cancer TX
5) Increased TX toxicity
6) Decreased QOL
I say “anorexia + early satiety + bloating” you say….
Reglan
Maybe Erythromycin
I say “anorexia + fatigue +nausea/pain” you say….
Dexamethasone
Or Marinol (for AIDS pts only… no efficacy in cancer)
I say “anorexia + fatigue” you say…
Dexamethasone
Methyphenidate
I say “anorexia + depression + insomnia/anxiety”
Mirtazapine
Olanzapine
Treatment of refractory cachexia for cancer? What if LE < 6 weeks?
Megace (can cause DVT, muscle catabolism, adrenal suppression, hypogonadism)- on Beers List
Better if they have weeks to months prognosis
For SHORT life expectancy, can think about dexamethasone
Drugs that are effective in RENAL pruritus? (3)
1) Gabapentin
2) Zofran
3) SSRIs
Drugs that are effective in CHOLESTASTIC pruritis? (5)
1) Cholestyramine
2) Rifampin
3) Naloxone
4) SSRI (Sertraline)
5) Zofran
Opioid Induced Constipation treatment
1) Start with stimulants and osmotics
2) NEVER use colace or bulk forming agents
3) Can try sodium chloride channel activators- lubiprostone (not good for methadone OIC), linaclotide
4) Naloxegol (not in cancer patients) or Methylnaltrexone great options
Opioid Induced Constipation
Impacts 45-90% of opioid users
- Lengthens colonic time
- More reabsorption of water from GI tract (dry, hard stools)
- Inhibits peristalsis in bowels
- Inhibits defecation reflex
Starts happening MINUTES after taking it (5-25)
DURATION of opioid use relates to likelihood of constipation
ALWAYS offer ppx (no tolerance develops_
Can increase M+M, hospital visits, ER visits, QOL
Double blind RCT for Octreotide outcomes?
No difference between Octreotide vs Placebo at 72 hours (any vomiting at 72 hours)
BUT you threw up less on octreotide
Diarrhea caused by irinotecan or 5FU should be treated with what drug?
Irinotecan and 5FU chemotherapy can cause a secretory diarrhea that is best treated with octreotide.
Risk factors for cancer related fatigue?
○ Unmarried, lower SES
○ Medical comorbidities
○ Poor nutrition
○ Mood disorders
○ Polypharmacy
○ High symptom burden
○ NOT ALWAYS CORRELATED with TYPE or treatment or DOSE intensity
Can be super tired even with short, brief chemo!
Treatment for mucositis?
- Oral hygiene
- Mucosal coating agents
- Topical analgesics (lidocaine, morphine +doxepin)
- Topical dexamethasone
Prevention of mucositis?
- Benzydamine (for ENT cancer)
- Chlorhexadine
- Zinc daily
- Ice/cold
When will UV therapy help with pruritus?
Renal failure
ESLD
Hodgkin’s lymphoma
HIV
Breast carcinoma w/ skin infiltration
Approach to management of opioid induced itching?
1) Rotate opioid
2) Sertraline/Paxil/Remeron
3) Naltrexone
4) Zofran
Dressings for super WET wounds?
Alginates
Charcoal
Iodosorb
Approach to TX hiccups
1) TX underlying cause (GERD- PPI!)
2) Stop hiccup causing meds (dexamethasone, opioids, benzos)
3) NON PHARM options! breath holding, eat sugar, fright
4) Drugs
Drugs to TX hiccups
1) Thorazine
2) Haldol
3) Reglan (use this if also having gastric distention)
4) Baclofen
5) Gabapentin
6) Phenytoin (if CNS cause), depakote, carbamazepine
For dysphagia- why should you NOT do thickened liquids?
No difference in risk of aspiration/pneumonia
INCREASED risk of pneumonia with honey thick liquids
INCREASED risk of dehydration
FT question–> answer is USUALLY careful hand feeding
When to consider PleurX vs Pleurodesis?
Indwelling tunneled pleural catheter
-Better for intermediate PX (1-6 months)
-Indicated if any evidence of TRAPPED LUNG
Pleurodesis
-MAY be better for extended prognosis (» 6 months)
-Cannot use if patients have trapped lung
Overall- No real difference between PleurX vs Pleurodesis
- Pleurodesis spent more time in hospital (IP procedure), more painful
-20% ended up needing thoracentsis or PleurX
- PleurX needed fewer additional interventions
- BOTH highly effective for dyspnea 2/2 effusions (80% got symptom relief at 6 mos in RCT)
TX options for chronic cough?
1) TX underlying cause
2) OPIOIDS (no opioid better than other)
3) Dextromethorphan better than placebo
4) Gabapentin MAY be helpful w/ chronic cough
TX for XRT pneumonitis?
60 mg prednisone daily tapered slowly over months for RADIATION INDUCED pneumonitis
