化疗引起的恶心呕吐的预防与管理 ppt课件.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Speaker notes: ? Points to emphasize or? highlight: We can see that the incidence of delayed CINV is very high but we actually call back patients which will increase the numbers * * * * * * * * * * * * * * Speaker notes: ? Points to emphasize or? highlight: Need to introduce here the concepts of ultra, poor and extensive metabolizer * * * * * * * * * Case 1: Question 3 What other actions can the pharmacist take to help M.T. control her CINV? Answer Question 3 Explore patient adherence with anti-emetics. Assess effectiveness/ineffectiveness of anti-emetic plan. Follow up toxicity assessments (use CCO telephone toxicity guidelines). CINV education. Communication with her other health care providers. Patient nausea diary (CANO patient education for CINV). Promote patient involvement through patient resources: Chemotherapy and You: A Guide to Self-Help During Cancer Treatment, /cancerinfo/chemotherapy-and-you Case 1: Question 4 The pharmacist asks the patient what medications she is currently taking. She informs the nurse she is taking Warfarin, Metoprolol and ASA. Should she be concerned about a drug interaction with Warfarin and Aprepitant? Case 1: Question 5 Which of the following may occur with the addition of aprepitant to M.T’s regimen? A. INR may decline B. INR may increase C. Warfarin levels may rise Answer Question 4 and 5Warfarin Aprepitant Interaction Aprepitant is a CYP3A4 substrate, a 3A4 inhibitor and inducer, and a 2C9 inducer. INR may decline. Adapted from Aprepitant Monograph. Retrieved July 22, 2008 from http://www.cancercare.on.ca/pdfdrugs/aprepitant.pdf Importance of Medication Reconciliation Pilot Project of Medication Reconciliation in St. John’s, Newfoundland Cancer Center Summer project Pharmacy Students Obtaining an accurate medication history for chemotherapy patients Total Numb