MNT for Primary Brain Tumors

Question 1

Hyperglycemia in pts with Brain Tumors

Answer 1

Pts with PBT typically receive dexamethasone to decrease peritumoral edema and RT side effects

Question 2

Ketogenic diet in PBT

Answer 2

Not standard of care in PBT, but increasingly used as an adjuvant therapy. Warburg effect - cancel cells rely on increased glycolysis for energy rather than mitochondrial based oxidative phosphorylation -> theory that changing brain’s energy source from glucose to ketones can induce oxidative stress within cancer cells, leading to apoptosis. Classic ketogenic diets have strict ratios of fat g: cho g + pro g i.e. 3:1, 4:1. Everything must be weighed and measured. Modified atkins diet limits total cho to 10-20g/day

Question 3

Temodar

Answer 3

N/V/C, fatigue - take on empty stomach

Question 4

Procarbazine (Matulane)

Answer 4

N/V, anorexia, stomatitis - avoid ETOH, avoid high tyramine foods

Question 5

Lomustine (CCNU)

Answer 5

N/V, anorexia, stomatitis, no ETOH

Question 6

Vincristine (Oncovin)

Answer 6

Constipation, wt loss, N/V, no ETOH

Question 7

Irinotecan (Camptosar)

Answer 7

Diarrhea (I-ran-to-the-can), anorexia, N/V

Question 8

Carmustine

Answer 8

N/V

Question 9

Bevacizumab (Avastin)

Answer 9

anorexia, stomatitis, N/V/C/D

Question 10

Keppra

Answer 10

Diarrhea, fatigue, anorexia

Question 11

Vimpat

Answer 11

Nausea

Question 12

Lamictal

Answer 12

nausea, dyspepsia, constipation

Question 13

Depakote

Answer 13

diarrhea, change in appetite, wt gain or loss, constipation

Question 14

dexamethasone (Decadron)

Answer 14

increased appetite, hyperglycemia, muscle weakness, impaired wound healing