9: Symptom Management

Question 1

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Can help with bowel movements. Correlation between constipation and nausea.

Answer 1

Anticholinergic

Question 2

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Not usually used as single-modality approach. Very helpful for adjuvant therapy.

Answer 2

Dopamine 2 antagonist

Question 3

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Specifically designed for chemotherapy-induced nausea and vomiting. May not work for disease-caused n/v or mass effect.

Answer 3

5-HT3 antagonist

Question 4

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Zofran

Answer 4

5-HT3 antagonist

Question 5

T/F Nausea is caused by the chemo treatment and not the cancer.

Answer 5

False. It can be caused by both. Bulky abdominal tumor pushing on stomach can cause nausea.

Question 6

Pharm interventions for fatigue?

Answer 6

Psychostimulants (Ritalin, Adderall). May be necessary to educate patients about benefits, since used to treat ADD/ADHD. Helps with fatigue, appetite, concentration/focus (chemo brain).

Question 7

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
N/V caused by liver capsule stretch.

Answer 7

Steroid or anti-inflammatory

Question 8

Long or short acting opioid?

Oxycodone

Answer 8

Short

Question 9

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Good for predosing before chemo.

Answer 9

Dopamine 2 antagonist

Question 10

Sharp, knife-like pain is probably _____.

Answer 10

Neuropathic

Question 11

Common symptoms during cancer treatment (3).

Answer 11

1. Pain
2. N/V
3. Fatigue

Question 12

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Reduces inflammation caused by cancer.

Answer 12

Steroids

Question 13

Long or short acting opioid?

Fentanyl patches

Answer 13

Long

Question 14

Is a short or long acting opioid tried first?

Answer 14

Short. Typically start with 5 mg oxycodone q4h PRN.

Question 15

Long or short acting opioid?

MSIR

Answer 15

Short

Question 16

What lifestyle changes can help with n/v (4)?

Answer 16

1. Small, frequent meals.
2. Consider food odor/fat content (pancreatic patients have reduced enzymes to break down fat).
3. Cool, carbonated beverages.
4. Takes meds after meals (except for anti-emetics).

Question 17

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Less sedating than Zofran.

Answer 17

Dopamine 2 antagonist

Question 18

Deep, aching pain is probably _____.

Answer 18

Visceral

Question 19

_____ is closely linked to depression: less one does, less one wants to do.

Answer 19

Fatigue

Question 20

10 mg IV morphine is = _____ oxycodone and _____ hydromorphone.

Answer 20

Morphine = 10 mg
Oxycodone = N/A
Hydromorphone = 1.5 mg

Question 21

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Helps patient stay ahead of nause. Can be used several days after chemo.

Answer 21

Dopamine 2 antagonist

Question 22

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Reglan

Answer 22

Anticholinergic

Question 23

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic?
Ativan

Answer 23

Benzo

Question 24

Nonpharm interventions for fatigue (4).

Answer 24

1. Cluster activities
2. Make a schedule
3. Take naps
4. Schedule walks

Question 25

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic? Can help with gastric motility.

Answer 25

Anticholinergic

Question 26

Long or short acting opioid? | OxyContin

Answer 26

Long (contin = continuous)

Question 27

What short-acting dose indicates need for long-acting opioid?

Answer 27

If patient requires 4-6 doses of oxycodone/day, consider long-acting opioid.

Question 28

Long or short acting opioid? | Methadone

Answer 28

Long

Question 29

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic? Can help with n/v from metastatic brain disease or brain cancer.

Answer 29

Steroids

Question 30

30 mg PO morphine is = _____ oxycodone and _____ hydromorphone.

Answer 30

``` Morphine = 30 mg Oxycodone = 20 mg Hydromorphone = 7.5 mg ```

Question 31

Name n/v etiologies (6).

Answer 31

``` V = Vestibular O = Obstruction M = Motility/Metabolic/Mass I = Inflammation/Infection T = Toxins (drugs/chemo) S = Stretch (liver, kidney capsule) ```

Question 32

Which anti-emetic: Steroid, anti-inflammatory, 5-HT3 antagonist, Dopamine 2 antagonist, benzo, anticholinergic? Compazine

Answer 32

Dopamine 2 antagonist

Question 33

Long or short acting opioid? | Hydromorphone (Dilaudid)

Answer 33

Short

Question 34

Long or short acting opioid? | MS Contin

Answer 34

Long (contin = continuous)

Question 35

Why is a pain diary helpful?

Answer 35

Helps dose long-acting opioids if needed.