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    Nausea &vomiting: Anky Tri Rini Kusumaning Edhy

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    Ifah Inayah D'zatricha
    A 15-year-old boy with stage IV osteosarcoma and lung metastases is experiencing significant nausea and vomiting from chemotherapy and opioids, making hydration difficult. The medical team is discussing treatment options with the patient and his parents. Nausea and vomiting can be caused by the underlying cancer, medications like chemotherapy and opioids, or other issues. Management may include treating the underlying cause, anti-emetic medications that target different receptor types, integrative approaches, and following ASCO guidelines for multimodal anti-emetic therapy.

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    Nausea &vomiting: Anky Tri Rini Kusumaning Edhy

    Uploaded by

    Ifah Inayah D'zatricha
    18 views12 pages
    A 15-year-old boy with stage IV osteosarcoma and lung metastases is experiencing significant nausea and vomiting from chemotherapy and opioids, making hydration difficult. The medical team is discussing treatment options with the patient and his parents. Nausea and vomiting can be caused by the underlying cancer, medications like chemotherapy and opioids, or other issues. Management may include treating the underlying cause, anti-emetic medications that target different receptor types, integrative approaches, and following ASCO guidelines for multimodal anti-emetic therapy.

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    A 15-year-old boy with stage IV osteosarcoma and lung metastases is experiencing significant nausea and vomiting from chemotherapy and opioids, making hydration difficult. The medical team is discussing treatment options with the patient and his parents. Nausea and vomiting can be caused by the underlying cancer, medications like chemotherapy and opioids, or other issues. Management may include treating the underlying cause, anti-emetic medications that target different receptor types, integrative approaches, and following ASCO guidelines for multimodal anti-emetic therapy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    18 views12 pages

    Nausea &vomiting: Anky Tri Rini Kusumaning Edhy

    Uploaded by

    Ifah Inayah D'zatricha
    A 15-year-old boy with stage IV osteosarcoma and lung metastases is experiencing significant nausea and vomiting from chemotherapy and opioids, making hydration difficult. The medical team is discussing treatment options with the patient and his parents. Nausea and vomiting can be caused by the underlying cancer, medications like chemotherapy and opioids, or other issues. Management may include treating the underlying cause, anti-emetic medications that target different receptor types, integrative approaches, and following ASCO guidelines for multimodal anti-emetic therapy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 12

    NAUSEA &VOMITING

    Anky Tri Rini Kusumaning Edhy


    CASE

    A, 15 yo high school, diagnosed stage IV Osteosarcoma with multiple


    lung nodules. He got chemotherapy and higher dose opioids and it’s
    creating significant side effect.
    He has already got adequate anti vomiting.
    He has significant vomiting and nausea, so it leads to difficulty in
    staying hydrated.
    The team is talking with A and his parents about the options
    What is your opinion about the case?
     Cause : medis ? Non medis ?
     Treatment ?
    EVALUATION AND ASSESSMENT

    History and Physical examination


    Onset
    Quality
    Associations
    Does vomiting provide relief?
    Medications
    Associated symptoms
    NAUSEA/ VOMITING MECHANISMS
    MANAGEMENT

    Treat underlying cause : ileus, drug adverse effects, anxiety


    Integrative approaches :
    Provide small meals chosen by child
    Provision of favourite drinks
    Hypnosis, breathing techniques
    Good oral care
    Avoid discomforting smells
    Aromatherapy
    Acupressure
    ANTI EMETICS
    - 5 HT3 Receptor antagonists :
     Ondansetron / Granisetron
    - D2 Receptor antagonists :
     Metoclopramide/ Haloperidol  extrapyramidal reactions
    - Domperidone  no extrapyramidal reactions, does not cross the blood
    brain barrier
    - H1 and Achm receptor antagonist :
     Diphenhydramine, promethazine
    OPIOIDS  NAUSEA AND VOMITING

    - Induces activation of the chemoreceptor trigger zone


    - Peripheral pathway activation
    - Sensitization of the labyrinth and activation of the vestibular system

    Treatment :
    1. Opioid rotation
    2. low dose naloxone : 0,5-2 mcg/kg/hour
    3. D2 receptor antagonist and or antihistamine/ anticholinergic
    CHEMOTHERAPY  NAUSEA AND VOMITING

    Types : Treatment :
    - 5 HT3 receptor
    1. Acute Emesis
    antagonists
    2. Delayed Emesis - NK1 receptor antagonist
    3. Anticipatory Emesis - Glucocorticoids
    - Benzodiazepines
    ASCO GUIDELINES
    EMPIRIC MULTIMODAL ANTI EMETICS

    First line :
    5HT3 receptor antagonist and/ or
    D2 receptor antagonist and/ or
    H1 & Achm receptor antagonist
    Second line :
    Consider adding corticosteroid
    Adding low dose benzodiazepine
    Consider substituting phenothiazine for both antihistamine and
    dopamine antagonist
    Third line :
    Consider adding cannabis
    Consider aprepitant
    Consider low dose propofol

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