培训课件--PPI在肿瘤化疗期间的应用价值.pptVIP

* * Breakthrough emesis presents a difficult situation as correction of refractory ongoing nausea/vomiting is often challenging to reverse. It isgenerally far easier to prevent nausea/vomiting than to treat it. The general principle of breakthrough treatment is to give an additional agent from a different drug class. No one drug class has been shown to be superior for the management of breakthrough emesis, and the choice of agent should be based on assessment of the current prevention strategies used. Some patients may require several agents utilizing differing mechanisms of action. One should strongly consider routine, around-the-clock administration rather than PRN dosing. The PO route is not likely to be feasible due to ongoing vomiting, therefore, rectal or IV therapy is often required. Multiple concurrent agents, perhaps in alternating schedules or by alternating routes, may be necessary. Dopamine antagonists eg,metoclopramide, haloperidol , corticosteroids, and agents such as lorazepam may be required. Ensure adequate hydration or fluid repletion, simultaneously checking and correcting any possible electrolyte abnormalities. Prior to administering the next cycle of chemotherapy the patient should be reassessed, with attention given to various possible nonchemotherapy-related reasons for breakthrough emesis with the current cycle: Brain metastases Electrolyte abnormalities Tumor infiltration of the bowel or other gastrointestinal abnormality Other comorbidities Prior to the next cycle of chemotherapy, reassess both the day 1 and post-chemo antiemetic regimen which did not protect the patient during the present cycle, and consider alternatives: Suggestions are not in order of preference Add aprepitant if not previously included. Add other concomitant antiemetics, eg, dopamine antagonists or haloperidol Possibly adjust dose s , either intensity or frequency, of the 5-HT3 antagonist. Based on the patients experiences, the chemotherapy regimen in question may ac