A patient who is about to begin chemotherapy expresses concern to ...

[ENagel]

A patient who is about to begin chemotherapy expresses concern to the primary care NP about gastrointestinal side effects of the treatments. The NP should reassure the patient that:
 
  a. most newer chemotherapeutic agents do not cause nausea and vomiting.
  b. antiemetics will be administered as needed if nausea and vomiting occur.
  c. taking ondansetron before chemotherapy decreases nausea and vomiting.
  d. a scopolamine patch is an effective way to prevent nausea and vomiting.

Question 2

A patient who is taking methotrexate for RA sees the primary care NP for an annual physical examination. The patient's alanine aminotransferase (ALT) and AGT are elevated. The NP should:
 
  a. decrease the dose of methotrexate.
  b. recheck ALT and AGT levels in 2 weeks.
  c. contact the patient's rheumatologist to discuss discontinuing the drug.
  d. counsel the patient not to take acetaminophen while taking methotrexate.

[yahahah24021]

Answer to Question 1

C
In many situations, nausea and vomiting may be anticipated. These situations may involve motion sickness or chemotherapy. Premedicating the patient with an antiemetic may be necessary in order for the patient to receive full therapy; this is the current standard of care. Although most chemotherapeutic agents have emetogenic potential, the use of premedication with 5-HT3 receptor antagonists significantly decreases the nausea and vomiting experienced during and after administration The most common agent in this class, ondansetron, is now available as a generic.

Answer to Question 2

B
Liver enzyme elevations are frequent, are usually transient and asymptomatic, and do not appear predictive of subsequent hepatic disease. A decrease in dose or discontinuation of the drug is not indicated. Coadministration with acetaminophen is not contraindicated.