what are the common GI symptoms that are chemo-induced
nausea vomiting, diarrhea, constipation, mucositis
patient and treatment risk factors for CINV
Patient:
young(<50)
female
anxiety
low alcohol intake
hist of motion sickness
hist of prev CINV
hist of prev emesis during past preg
patient and treatment risk factors for CID
- > 65 yo
- female
- ECOG PS >2
- bowel inflammation/malaaborptive
- bowel malignancy
- biliary obstruction
7, 1st cycle of chemo - cycle duration greater than 3 weeks
- concomitant neutropenia
10: sx(anorexia, anemia, n/v, mucositis)
patient and treatment risk factors for constipation
- lowered fluid intake and dehydration
- loss of appetite
- lack of fiber or bulk forming food in the diet
- vitamin or mineral supplements (iron/calcium pills)
- overuse of laxatives
- low physical activity
- thyroid problems
- depression
- high levels of calcium or potassium in blood
- cancer growing into the large intestine pressing on the bowel
- drugs(opioid, antinuasea(ondansetron, granidetron), chemo)
patient and treatment risk factors for mucositis
Patient:
- autoimmune disorders
- female
- diabetes
- caucasians
- genetic
- folic acid or vit b12 deficiency
treatment:
- chemotherapy
- radiation
- smoking, alcohol
- presence of xerostomia/infection
pathophysiology of CINV
pathophysiology of CID
pathophysiology of constipation
pathophysiology of mucositis
MOA & PK of CINV drugs
NK1 nurokinin-1 antagonist:
5HT3 serotonin antagonist:
Dexamethasone:
Olanzapine(atypical antipsychotics):
Dopamine antagonist(metoclopramide):
Benzodiazepines:
Haloperidol:
Phenothiazides:
MOA & PK of CID drugs
uncomplicated:
- loperamide
complicated:
- octrotide
- antibiotics
MOA & PK of constipation drugs
stool softerner to hol dwater, keep it soft
laxatives to stimulate bowel actiivty - senna/mineral oil/ lactulose
laxative to increase fibre and produce bulk - psyllium
suppositories - glycerin, bisacodyl
enema - fleet, tap water
MOA & PK of mucositis drugs
Prevention:
1. IV palifermin 60mcg/kg/d x3 x2
2. benzydamine HCL mouth wash
3. LLLT therapy
4. oral cyrotherapy
Management:
1. Oracare suspension(nystatin, tetracyclin, hydrocortisone, diphenhydramine) - after food
2. mylocaine suspension (diphenhydramine, lignocaine) - b4 food
3. morphine sulphate solution - b4 food
4. oracort e
5. difflam mouthewash
6. soragel
7. medijel
ADR and DDI of CINV drugs
NK1 nurokinin-1 antagonist:
5HT3 serotonin antagonist:
Dexamethasone:
Olanzapine(atypical antipsychotics):
Dopamine antagonist(metoclopramide):
Benzodiazepines:
Haloperidol:
Phenothiazides:
ADR and DDI of CID drugs
ADR and DDI of Constipation drugs
ADR and DDI of mucositis drugs
Dosing of mucositis drugs
Dosing of CINV drugs
NK1 nurokinin-1 antagonist:
5HT3 serotonin antagonist:
Dexamethasone:
Olanzapine(atypical antipsychotics):
Dopamine antagonist(metoclopramide):
Benzodiazepines:
Haloperidol:
Phenothiazides:
Dosing of CID drugs
Dosing of constipation drugs
- fybrogel 1 sachet BD
- lactulose 10ml TDS
- senna 15mg ON
- forlax 1 sachet BD
severity grading of CID
NPM for CINV
- take frequent small meals
- avoid spicy, greasy, very sweet or very salty food
- sip small amounts of fluid often
- avoid caffeinated beverages
- avoid lying flat for 2hrs after eating
NPM for CID
- probiotics with lactobacillus
- diet modifications(avoid spicy, lactose containing, fatty)
- small, freq meals
- BRAT diet
- more than 3L of clear fluid containing salt and sugar
