Devita, Hellman, and Rosenberg's Cancer

LWBK1006-44 LWW-Govindan-Review November 24, 2011 11:30

Chapter 44•Management of Adverse Effects of Treatment 557

Answer 44.7. The answer is B.

With high emetic-risk chemotherapy, recommended antiemetic therapy

includes medications from the following classes: 5-HT 3 receptor antag-

onist (dolasetron, granisetron, ondansetron, tropisetron, palonosetron),

corticosteroids (dexamethasone), and NK1 receptor antagonist (aprepi-

tant). Phenothiazines, such as prochlorperazine, have a lower therapeutic

index.

Answer 44.8. The answer is A.

The pathophysiology of delayed CINV may be more dependent on Sub-

stance P as seen by the efficacy of NK1 antagonists in the delayed emesis

setting. Because 5-HT3 receptor antagonists and dopamine D2 antago-

nists have less efficacy in this setting, 5-HT and dopamine appear to have

a less important role in delayed CINV.

Answer 44.9. The answer is B.

Agents such as 5-fluorouracil, capecitabine, and irinotecan are chemother-

apy agents that commonly cause diarrhea. Docetaxel is also associated

with a mild diarrhea but can also cause severe enteritis and colitis.

Answer 44.10. The answer is C.

The celiac plexus transmits the sensation of pain arising from the pan-

creas and also carries sympathetic nerves. Interruption of the plexus with

alcohol injection may result in sympathetic blockade leading to diarrhea

and hypotension from unopposed parasympathetic activity. This is usu-

ally transient and lasts for 48 hours. Though pancreatic insufficiency and

enteral feeding may cause diarrhea, this is usually a chronic diarrhea and

are less likely in this setting.

Answer 44.11. The answer is A.

Octreotide has multiple methods of activity in the reduction of diarrhea.

It can suppress the release of insulin, glucagon, vasoactive intestinal pep-

tide, and gastric acid; reduce gastrointestinal motility and decrease pan-

creatic exocrine function; and alter the increased absorption of water,

electrolytes, and nutrients from the gastrointestinal tract.

Answer 44.12. The answer is C.

Drugs that commonly cause constipation in patients with cancer include

opioid analgesics, serotonin 5HT3 receptor antagonists, vinca alkaloids,

thalidomide, antidepressants, aluminum- or calcium-containing antacids,

iron supplements, and diuretics.

Answer 44.13. The answer is D.

Study results of chemotherapy-related stomatitis are conflicting, but some

patient-related factors include age more than 65 years or less than

20 years, female gender, inadequate nutritional status, herpes simplex