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After completing this case study, the reader should be able to:
Develop a prophylactic antiemetic regimen based on the emetic risk associated with cancer chemotherapeutic agents to optimize the management of nausea and vomiting.
Design an appropriate treatment regimen for anticipatory, breakthrough, acute, and delayed nausea and vomiting.
Design a monitoring plan to assess the effectiveness of an antiemetic regimen.
Discuss with patients and caregivers the reason for antiemetics, their appropriate use, and the management of side effects.
Recommend appropriate alternative antiemetic strategies based on patient-specific conditions, such as previous response to chemotherapy and side effects.
“I have stomach pain and back pain.”
Mr Jones is a 57-year-old man who presents to the ED with complaints of lower back and abdominal pain, decreased appetite, and constipation since previous discharge from the hospital 3 days ago. He was recently hospitalized for prolonged abdominal pain, fatigue, a persistent cough, and a 14-lb weight loss over the previous 2 months. An ultrasound revealed marked cholelithiasis with changes of chronic cholecystitis for which he was started on amoxicillin/clavulanate. He was found to have a 1.4-cm pulmonary mass in the lower left lung associated with endobronchial obstruction, a 4-mm noncalcified left pulmonary nodule, slightly enlarged left hilar lymph nodes, and an enlarged liver with evidence of metastasis. A diagnosis of small-cell lung cancer was made with the plan to begin treatment in the outpatient setting. He currently reports that he does not have trouble swallowing but does have a productive cough. The sputum occasionally clears but is usually a brownish color.
Father died at age 82 of heart and renal failure; mother died at age 68 with emphysema, obesity, MI, hypertension; two sisters, one with diabetes; three adult children, alive and healthy.
Single and works as a salesman at a car dealership. He has smoked 1–1.5 packs of cigarettes a day starting at the age of 14. He still smokes but has cut back because his employer has a campus-wide no smoking policy. History of alcohol and substance abuse, but he has not had alcohol for 14 years.
Complaints include hoarseness for 1 week and fatigue. Lower extremity weakness, productive cough with brownish sputum, abdominal pain and bloating, nausea, and constipation.
Ibuprofen 400 mg PO TID with food
Esomeprazole 40 mg PO daily
Oxycodone ER 10 mg PO Q 12 ...