IC5 Management of GI Flashcards

Question

olanzapine moa

Answer 1

antagonist of dopamine, serotonin, histamine, cholinergic

Answer 2

5 to 10mg OD consider 2.5mg for elderly

Answer 3

fatigue, sedation, postural hypotension, anticholinergic SE

Answer 4

used for acute CINV therapy in low emetic regimens used for breakthrough CINV

Answer 5

Blockade of dopamine receptors in the chemoreceptor trigger zone; stimulation of cholinergic activity in the gut, increasing (forward) gut motility; and antagonism of peripheral serotonin receptors in the intestines.

Answer 6

mild sedation diarrhoea EPSE (dystonia = muscle stiffness and spasms, twitching or difficulty in speaking or swallowing; akathisia =restlessness )

Answer 7

avoid taking with olanzapine increases risk of EPSE and toxicity - tardive dyskinesia = Uncontrollable movements (such as in the face, tongue, jaw or other parts of the body) - neuromalignant syndrome = fever, stiffness, confusion, irregular BP IMPORTANT to separate during the first two days of their antiemetic regiment + not a big concern since PRN dosing and low dose. counsel patient to watch for these symptoms.

Answer 8

anticipatory CINV

Answer 9

BIND to BZP receptors on post synaptic GABA neuron to enhance inhibitory effect of GABA

Answer 10

PO alprazolam 0.5-1mg OR PO lorazepam 0.5-2mg on the night before chemotherapy AND 1-2h before chemo

Answer 11

drowsy dizziness hypotension anterograde amnesia paradoxical reactions caution elderly = risk of falls

Answer 12

for refractory CINV = butyrophenones (haloperidol) = phenothiazines (prochloperazine, promethazine, chlorpromazine) both block dopamine receptors in CTZ

Answer 13

po / iv 0.5 mg q4-q6h sedation, EPSE, etc

Answer 14

prochloperazine po 10mg TDS- QDS prn adr: SEDATION, hypotension, EPSE (including dystonia, akathisia) - same as meto

Answer 15

IF ongoing vomiting

Answer 16

fluid repletion and hydration for losses. reassess next cycle antiemetics cnsider use of several agents utilizing different mechanism of actions (AND diff drug class) if necessary check for adherence

Answer 17

1) take small, frequent meals 2) avoid greasy, spicy, very sweet/salty food OR food with strong flavours/smells 3) sip small amounts of fluid instead of full glass 4) avoid caffeinated beverages 5) avoid lying flat 2h after eating

Answer 18

Give appropriate prophylactic therapy for expected emetogenicity on each day of chemotherapy administration * Continue delayed prophylaxis alone for 2-3 days after completion of chemotherapy if indicated

Answer 19

use optimal anti emetic therapy during every cycle of treatment relaxation and systematic desensitisation hypnosis/guided imagery music therapy acupuncture/acupressure use of BZP before treatment

Answer 20

abnormal electrolytes inappropriate fluid balance malnutrition renal failure weight loss fatigue dehydration

Answer 21

>65 yo female ECOG performance status ≥2 bowel inflammation/malabsorption bowel malignancy biliary obstruction x6

Answer 22

1st chemo chemo duration more than 3 weeks concomitant neutropenia associated sx: anemia, anorexia, vomiting, mucositis

Answer 23

direct damage and inflammation of the intestinal mucosa resulting in imbalance between absorption and secretion.

Answer 24

GRADE 1) increase <4 per day above baseline 2) 4-6 + limit ADL 3) ≥7 + hospitalisation + limit self care 4) life threatening and urgent intervention needed

Answer 25

uncomplicated - grade 1 and 2 - no complications complicated - grade 3 and 4 - grade 1 and 2 with complicating sx of atleast ≥1 = cramps, grade 2 N/V = fever, sepsis, neutropenia = frank bleeding (eg haemorrhoids, fissures) = dehydration

Answer 26

opioid inhibiting smooth muscle contraction in intestine to decrease motility

Answer 27

for grade 2 = withhold chemo until sx resolve OR reduce dose diet = oral rehydration with 8-10 glass of clear liquid loperamide 4mg STAT then 2mg every 4h or after each episode (no max dose), continue until 12hour free of diarrhoea... if improvement after 12-24h, continue diet modification and begin to add solid foods if persist after 12-24h, - loperamide 2mg q2h - PO abx (IMPT) - if progress to complicated = treat accordingly - if after another 12-24 (with loperamide), stop loperamide, start octreotide or second line agent (FYI).

Answer 28

decrease mortality and morbidity improve QOL and ADL improve recovery of intestinal mucosa decrease hospitalisation

Answer 29

withhold chemotherapy and restart with lower dose octreotide SC 100-150mcg TDS or 25-50mcg/hr continuous IV = increments of 50mcg after 24h = increase to max 500mg TDS start IV fluid hydration start IV abx (cipro x7days)

Answer 30

n/v dry mouth dizzinss drowsiness rash constipation bloating abdominal pain

Answer 31

EARLY ONSET onset within 24h after admin mean sx duration 30min dose dependent = more sx during infusion mainly due to acute cholinergic properties

Answer 32

bradycardia, arrhymia constipation, abdo pain, n/v headache, dizziness enlarged thyroid

Answer 33

decrease hormone secretion = 1)increased transit time within intestines, 2) decreases secretion of fluid, 3) increased absorption of fluids and electrolytes

Answer 34

PROBIOTICS with lactobacillus (IMPT) avoid alcohol, caffeine, **fruit juice**, lactose foods, spicy foods, high fibre foods, high fat foods, dietary supplements with high osmolarity eat small frequent meals BRAT diet (banana, rice, applesauce, toast) >3L of clear fluids containing sugar and salt avoid lactose foods a week after CID resolution

Answer 35

conversion in liver to active metabolite SN38 - enterohepatic recycling - 100-1000x more cytotoxic in parent drug + main diarrhoea cause causing crypt ablation, villus blunting, atrophy of epithelium of small/large intestine

Answer 36

1) homozygous for UGT1A1*28 = decreased expression of UGT1A1, responsible for conversion to SN38-G (deactivation by glucoronidation) 2) bacteria in gut produce beta glucoronidase = reactive SN38-G to SN38 via deconjucation

Answer 37

SC/IV atropine 0.25-1mg (max 1.2; usually sc) MOA; inhibit acetylcholine at msucarinic receptor via competitive antagonism. - note irinotecan is a reversible, selective acetylcholine esterase = cause cholinergic response

Answer 38

insomnia, dizziness tachycardia, blurred vision, dry mouth, consipation contrdinciation in glaucoma

Answer 39

LATE ONSET after 24h from admin not dose or frequency dependent - median 6 days with q3week dosing - median 11 days with weekly dosing

Answer 40

loperamide 4mg with first loose stop then 2mg q2h (4mg q4h (night)) until 12h of no bowel movement

Answer 41

1) lower fluid intake / dehydration 2) loss of appetite / anorexia 3) lack of fibre/bulk forming foods 4) vitamin or mineral supplements eg iron or calcium pills 5) overuse of laxatives 6) low lv of phy activity / alot of bed rest 7) thyroid problems 8) depression 9) high serum calcium/potassium 10) cancer growing into large intestine/pressing into spinal cord

Answer 42

* Bloating or feeling of fullness * Cramping or pain * Gas, or flatulence * Belching * Loss of appetite * No regular bowel movement for 2 or more days * Straining to have a bowel movement * Small hard stools that are difficult to pass * Rectal pressure * Leakage of small amounts of stool resembling diarrhea * Swollen, or distended, abdomen * Nausea or vomitng

Answer 43

opioids chemo drugs (vinca alkaloids: vincristine, vinblastine, vinorelbine) antinausea (5ht3 receptors antagonists) anticonvulsants

Answer 44

eat more fibre eat natural laxatives increase phy activity

Answer 45

stimulant laxatives - Senna 15mg ON bulk forming laxatives - fibrogel 1 sachet BD (isphagula husk) osmotic laxatives /stool softener - lactulose 10-15ml TDS - macrogol (forlax 1 sachet BD) enemas and suppositories - enemas clean out bowel or deliver laxatives eg fleet phosphate enema

Answer 46

low WBC or platelet count due to infection risk OR bleeding.

Answer 47

WHO: 0) NO EVIDEENCE 1) erythema and soreness 2) ulcers, can eat solids 3) ulcers, liquid diet 4) ulcers, cannot PO 5) n/a CCTAE 0) NA 1) Asymptomatic or mild, no intervention 2) moderate pain, modified diet 3) severe pain, interfere with PO 4) life threatening 5) death

Answer 48

PATIENT RELATED - autoimmune disorder - diabetes - female - folic acid or vit b12 deficiency CHEMOTHERAPY (risk increases with any other factors that increase dose and frequency) RADIOTHERAPY (furhter increased with smoking, alcohol, or presence of xerostomia/infection)

Answer 49

prevent and decrease severity manage pain and associated sx prevent chemo delays or dosage reductions

Answer 50

1) paliferm after high dose chemo and TBI for autologous HSCT 2) benzydramine hcl mouthwash after radiation 3) oral cryotherapy

Answer 51

keratinocyte growth factor - reduce duration and severity - iv 60mcg/kg/day for three consecutive days before and after myelotoxic therapy (total 6) = third dose 24-48h prior = forth dose on same day as HSCT and within 4 days of third dose

Answer 52

reduces mucositis by causing vasoconstriction and decreasing blood flow to the GI mucosal

Answer 53

Oracare Suspension (Nystatin 125,000U, Tetracycline 62.5mg, hydrocortisone 5mg, diphenhydramine 11.5mg/10mL) Mylocaine suspension (diphenhydramine 11.5mg, lignocaine 16.7mg/10mL) Morphine sulfate solution 1mg/mL

Answer 54

mylocaine and morphine meant to stop pain before meals. take 15min - 1h before then oracare after food to remove bacteria SAFE TO SWLLOW AVOID ALCOHOL BASED

Answer 55

oracort (lidocaine + triamcinolone) soragel (choline salicylate) difflam spray (benzydamine) difflam gargle

Answer 56

oral 7 mouthwash bioxtra mouthwash AVOID ALCOHOL BASED like listerine = drying effect may cause xerostomia (mouth dryness)

IC5 Management of GI Flashcards

(80 cards)