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ONC EXAM 2 TREATMENT

DISEASE TREATMENT
HIGH EMIETIC RISK - 3-4 meds dexamethasone, 5HT (Palonosetron), and NK 1 (aprepitant) and olanzapine
MODERATE RISK - 2-3 meds dexamethasone, 5HT, (Palonosetron) and maybe NK 1 (aprepitant) or olanzapine
LOW RISK - 1 med dexamethasone or 5HT (serotonin receptor antagonist) (Palonosetron) or dopamine receptor antagonist
MINIMAL RISK - no meds No prophylaxis
Anticipatory N/V Lorazepam 1mg PO night before treatment and 1-2 hours before chemo Olanzapine 2.5mg PO night before chemo
Radiation emetic risk high-total body moderate-upper abdomen low-lower stomahch/pelvis/cranium/craniospinal minimal-head/neck/extremeties/breast high-5HT +/- dexamethasone before and 24 hours after moderate-5HT +/- dexamethasone before low-5HT before minimal-5HT PRN
CID 1-2 OTC dose loperamide, if no response escalate loperamide dose or give atropine/diphenoxylate if still no response give octreotide
loperamide 2mg OTC dose: 2 caps at onset then 1 for every loose stool (8mg daily max) Escalated dose; 2 caps at onset then 1 cap every 2-4 hours for 12 hours (24mg daily max) must be 12 hours period of no diarrhea while on loperamide to d/c loperamide
CID 3-4 no chemo, hospital admit, fluids/electrolytes, stool workup, potentially antibiotics octreoide 100-150 mcg subQ TID (100mcg IV contiuous/10-30mg IM Q28D)
Other diarrhea treatments absporbents: attapulgite, polycarbophil If c. diff ruled out: OTC loperamide, pepto in people over 12 y/o/ budesonide/tincture of opium
Irinotecan induced early: cholinergic (from AcHe inhibition), in first 24 hours late: SN-38 metabolite, after 24 hours early: atropine late: loperamide
abemaciclib induced diarrhea starts within first 6-8 days loperamide 16mg daily total 4mg at onset 2mgq-2-4hr 12hrs Rx: diphenoxylate/atropine, opium tincture
Checkpoint inhibitor colitis steroids, no response then IV steroids, no response then infliximab or vedolizumab
Created by: beezy41
 

 



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