D. trễ nôn xảy ra hơn 24 giờ sau khi hóa trị liệu chính quyền và có thể ảnh hưởng đáng kể mức độ của bệnh nhân dinh dưỡng và hydrat hóa. Trong trường hợp nôn chậm, antiemetic các đại lý nên được sử dụng miễn là cần thiết. Việc bổ sung các loại thuốc như dexamethasone, | Page 372 Table Emetic Potential of Chemotherapeutic Agents Emetic potential Chemotherapeutic agent VERY HIGH 90 Cisplatin Cyclophosphamide high dose Cytarabine Dacarbazine Mechlorethamine hydrochloride Streptozocin HIGH 60 -90 Carboplatin Carmustine Cyclophosphamide standard dose Dactinomycin Daunorubicin Doxorubicin Lomustine MODERATE 30 -60 Etoposide 5-Fluorouracil Idarubicin hydrochloride Ifosfamide Mitomycin Mitoxantrone Procarbazine hydrochloride Topotecan hydrochloride LOW 0 -30 Adriamycin Bleomycin Busulfan Cytarabine Docetaxel Hydroxyurea Melphalan Methotrexate 6-Mercaptopurine Taxol Thioguanine Thiotepa Vinblastine sulfate Vincristine sulfate Page 373 D. Delayed emesis occurs more than 24 hours after chemotherapy administration and may significantly affect the patient s level of nutrition and hydration. In cases of delayed emesis antiemetic agents should be used as long as necessary. The addition of drugs such as dexamethasone diphenhydramine lorazepam and metoclopramide may be useful in controlling delayed emesis and promoting oral intake. E. Numerous antiemetic medications are available with a wide range of cost. The use of serotonin antagonists such as granisetron and ondansetron should be reserved for use with chemotherapeutic agents of moderate to very high emetic potential. Often combinations of standard antiemetic medications can provide excellent relief at lower cost. IV. Pain and Sedation A. Proper assessment of pain is essential to achieving effective intervention. Assessment of pain should address onset duration location radiation quality intensity pattern aggravating factors and alleviating factors. intensity of pain may be described by use of a numeric scale in adolescents and adults. In children the use of a visual scale may be helpful. B. In BMT pain is generally the result of the underlying disease. The toxicities inherent in the transplant process limit the choice of analgesic agents since some agents con compound these toxicities. C.
