Symptomatic Tx and Complications of Cancer Flashcards
When should you increase a pts LA opioid?
When BTP is used 4 or more times daily
Starting opioid therapy regimen
Start on short acting for a few days
Calc 24 hr usage and convert to LA
Keep 10% short acting for BTP
Increase dose if BTP used 4+ times
Increasing an opioid dose
Add total daily dose (BTP+LA)
Keep 10% short acting for BTP
Decreasing opioid dose
Taper by less than or =25%
to prevent withdrawal
Changing opioid drugs
Convert equal dose and
decrease by 25% b/c
incomplete cross tolerance
All opioid conversions are based on
Morphine
10mg IV morphine is equal to…
2 IV hydromorphone
8 PO hydromorphone
AND
30 mg PO morphine, oxy, hydro
***Minus 25%
Conversions for morphine to methadone
If 1000 or less
Morphine 10 = 1 methadone
Minus 25%
If over 1000
Morphine 20 = 1 methadone
Minus 25%
Methadone is PO ONLY!
Long acting
Convert morphine to fentanyl
50-75 PO morphine
= 25 mcg/hr fentanyl
Then decrease by 25%
Opioids to avoid/use caution with in renal failure
Take Cover MOM Tramadol Codeine Meperidine Oxycodone Morphine
High risk emetogenic IV chemo drugs
AC Combo (doxorubicin or epirubicin + cyclophos) Cisplatin 50+ Cyclophos 1500+ Doxo 60+ Epirubicin 90+ Ifosfamide 10+ -all mg/m2
Mod Risk emetogenic IV chemo drugs
Carboplatin Cisplatin below 50 Cyclops below 1500 Doxo below 60 Epirubicin below 90 Ifosfamide below 10 MTX 250+ Oxaliplatin
Low Risk emetogenic IV chemo drugs
Cabazetaxel Docetaxel Eribulin Etoposide 5-FU Gemcitabine Ixa MTX 50-250 Mitox Paclitaxel Pemetrexed Topotecan
Tx for high risk IV emetogenic chemo drugs
Day 1 (3 drugs) -setron (SSRI) -dexamethasone (CCS) -aprepitant (NK-1) Day 2-4 (2 drugs) Dexa+aprepitant
Tx for mod risk IV emetogenic chemo drugs
Day 1 (2 drugs) -setron (SSRI) -dexamethasone (CCS) Day 2-3 (1 drug) either of the two above