Supportive Care TX Guide PDF

⭐ = DOC Myelosuppression - 3 questions Thrombocytopenia Platelet transfusion → 160/100 or 180/110 Treat with non-pharm Start amlodipine or ACE/ARB?? VTE Treatment: LMWH ⭐ Prophylax...

⭐ = DOC Myelosuppression - 3 questions Thrombocytopenia Platelet transfusion → 160/100 or 180/110 Treat with non-pharm Start amlodipine or ACE/ARB?? VTE Treatment: LMWH ⭐ Prophylaxis: - Ambulatory patient → Abixaban 2.5 mg BID? - 3 months → catheter related - 6 months → triggered event - Infedinit for active cancer NOO WARFARIN!  Oncological emergencies - 4 questions Febrile Single temperature of 101 OR 100.4 for ANC < 500 cells / mcL OR ANC expected to decreased neutropenia more than 1 hour to < 500 cells/mL in the next 48 hours Bacteremia & SSTI → Need coverage for pseudomonas, kleb, E.coli, staph and strep. MASCC > 21 = Low risk → IV ABX once MASCC 4), Doxo → 3 to 4 antiemetics → days 2,3,4, NK1 (if PO aprepitant used), dex, olanzapine DDI:Dexamethason **NK1 → Must be used in combo with steroid and zofran e dose must be decreased by 50% Moderate (90-30%): anthracyclines → 2 to 3 antiemetics → usually only 1 on days 2,3 (NK1 + when given dex or olanzapine or zofran) concurrently with aprepitant/fosapre Low (30-10%) Taxanes → 1 antiemetic used (dex, metoclopramide, prochlorperazine, zofran) pitant then PRN after chemo Minimal (10%)Vinca Alkaloids → No routine prophylaxis → breakthrough PRN if needed Diarrhea Loperamide → Opioid Lomotil → Opioid/anticholinergic Irinotecan Octreotide → Somatostatin Corticosteroids → Suppression of T cell function Constipation Vincristine → Autonomic neuropathy → paralytic ileus Vinca alkaloids Have patient on constipation meds! Mucositis Prevention → Oral hydration Treatment → Magic mouthwash Methotrexate Oral chemo Hand and foot Grade 1: Skin changes or dermatitis Non-pharm: syndrome without pain - Urea containing emollient TID Grade 2: Skin changes with pain but - Elevation to reduce swelling without Interference with function - Cold compresses Grade 3:Skin changes with pain and Pharmacologic: - Dose-reduction of causative medications, Interference with function pauses in therapy - Pain medications - Topical or oral corticosteroids Constipation Maintaining adequate hydration Miralax → good first option OTC stool softener → Docusate Stimulant laxative → Senna Nausea Ensure patient has access to prescribed anti-nausea medications - Ondansetron (zofran) - Prochlorperazine (Compazine) Any med that touches serotonin → QTc prolongation  Any med that touches dopamine → EPS Appetite stimulant → Dronabinol Gastroparesis → Metoclopramide Diarrhea → Ondansetron Survivorship Anxiety and Anxiety Depression depression GAD 7 score greater than 10 → refer PHQ-9 score greater than 8 → refer to specialist to specialist SSRI: GI toxicity, sexual dysfunction, decreased platelet aggregation, weight gain and QTc prolongation. DDI → Fluoxetine, paxil = CYP2D6 (Interaction with tamoxifen) SNRI: Good for nerve pain, GI toxic, increased blood pressure, hepatotoxic. DDI → Fluoxetine, paxil = CYP2D6 Mirtazapine: Sleep aid, appetite stimulant, antiemetic properties Bupropion: CNS stimulating effects (good for fatigue) → DDI cyp2D6 inhibition Distress Screen at initial visit and every visit after. A score of 4 or higher indicated moderate or severe distress → Referral should be made Cancer related Physical and emotional fatigue - Nonpharm: physical activity, yoga, acupuncture - Pharm: Methylphenidate Cognitive You can do a MMSE but not super great for cancer patients impairment Pharm: Methylphenidate