Etiology
Usual cause is side effect of chemotherapy treatment. Also suspect opiate therapy, GI and CNS radiotherapy, obstructive abdominal mass, CNS mass, certain antibiotics or hypercalcemia.
Presentation
Acute: Emesis within 24 hrs of starting chemotherapy occurs in one third of patients despite treatment.
Delayed: Emesis occuring 24 hrs after chemotherapy , increased risk in females, prior acute emesis and with certain agents e.g ciplatin.
Anticipatory: Emesis that occurs prior to chemotherapyadministration.
Treatment
Hydration plus one or more antinausea medications are needed.
1. Serotonin (5-HT3 ) antagonists
Ondansetron, dolasetron, granisetron. Usually a first line therapy. Patients may respond preferentially to one of these agents. Beware of QT prolongation, widening of QRS .
2. Histamin 1 Antagonist
Diphenhydramine, also cyproheptadine with anticholinergic side effect of appetite stimulation.
3. Steroids
Dexamethasone especially helpful in aptients with brain tumors. Synergy of unknown mechanism with 5-HT 3 antagonists.
4. Benzodiazepines
Lorazepam used as an adjunct antiemetic agent
5. Metoclopromide
Use diphenhydramine to reduse extrapyramidal symptoms.
6. Phenothiazines
Promethazine, chlorpromazine, use diphenhydramine to reduce EPS.
7. Cannabinoids
Dronabinol can be helpful in resistant cases especially in patients with large tumor burden. May also be used as an appetite stimulant in malnourished patients.
All thanks to this great herbal doctor who cured me from (LUPUS DISEASE) his name is dr imoloa. I suffered lupus disease for over 8 years with pains like: joints, Skin rash, Pain in the chest, swollen joints and many more. The anti-inflammatory drugs couldn’t cure me, until I read about his recommendation. 2 months ago, I contacted him through his email address. drimolaherbalmademedicine@gmail.com . and he sent me the herbal treatment through DHL courier service and he instructed me on how to drink it for good two weeks. after then, And I was confirmed cured and free at the hospital after taken his powerful herbal medications You too can be cured with it if interested, he also uses his powerful herbal healing medicine to cure disease like:parkison disease, vaginal cancer, epilepsy, Anxiety Disorders, Autoimmune Disease, Back Pain, Back Sprain, Bipolar Disorder, Brain Tumour, Malignant, Bruxism, Bulimia, Cervical Disk Disease, cardiovascular disease, Neoplasms, chronic respiratory disease, mental and behavioural disorder, Cystic Fibrosis, Hypertension, Diabetes, asthma, Inflammatory autoimmune-mediated arthritis. chronic kidney disease, inflammatory joint disease, back pain, impotence, feta alcohol spectrum, Dysthymic Disorder, Eczema, skin cancer, tuberculosis, Chronic Fatigue Syndrome, constipation, inflammatory bowel disease, bone cancer, lungs cancer, mouth ulcer, mouth cancer, body pain, fever, hepatitis A.B.C., syphilis, diarrhea, HIV/AIDS, Huntington's Disease, back acne, Chronic renal failure, addison disease, Chronic Pain, Crohn's Disease, Cystic Fibrosis, Fibromyalgia, Inflammatory Bowel Disease, fungal nail disease, Lyme Disease, Celia disease, Lymphoma, Major Depression, Malignant Melanoma, Mania, Melorheostosis, Meniere's Disease, Mucopolysaccharidosis , Multiple Sclerosis, Muscular Dystrophy, Rheumatoid Arthritis, Alzheimer's Disease Contacts him today and get permanently cure. contact him via... email- drimolaherbalmademedicine@gmail.com /whatssapp-+2347081986098.
ReplyDelete