Prophylactic antiemetic therapy

[jojoENZED]

Hi, hoping someone can help me with a question - I am currently working on an orthopaedic ward. Recently one of the patients I was allocated was admitted with sciatic pain which turned out to be melanoma. He was immediately commenced on a prophylactic regime of antiemetics pre-commencement of radiotherapy. The orthpaedic house surgeon charted the dexamethasone, cyclizine and a couple of other drugs on the front of the chart and dated it as commencing that day and then did a conseqential drug administration regime of altered dosages of the dexamethasone on the stat/standing order section of the drug chart for subsequent days. Flipping back and forth I made an error and started the Dexamethasone a day early, being the day of original charting. This was a total error on my part and I accept responsibility for it totally. However I have decided to exemplar my mistake for future learning. My CNL explained to me how important it was not to give the Dex on the first day of the regime, however I still dont "get it". Can anyone enlighten me on this process. The patient started his radiotherapy on day two of the regime.

[globalRN]

don't understand the question?

If the patient has melanoma and that was the cause of sciatica:

would assume spread of melanoma.

In oncology, steroids are often given to 'decompress' impingement

as in spinal cord compression or pain related to tumor invasion

since the dose of steroid is often =or more than what you might give for

antiemetic....you wouldn't need additional steroid for nausea

get extra bang for your tx buck

[globalRN]

don't understand the question?

If the patient has melanoma and that was the cause of sciatica:

would assume spread of melanoma.

In oncology, steroids are often given to 'decompress' impingement

as in spinal cord compression or pain related to tumor invasion

since the dose of steroid is often =or more than what you might give for

antiemetic....you wouldn't need additional steroid for nausea

get extra bang for your tx buck

or are you talking about a steroid taper?

if the steroid course is given for cancer pain

managemt...usually give the same dose for several days-2 weeks

before beginning a taper.

if pain comes back,....reintroduce at a higher dose than the one patient

was on while on taper

[heamoRN]

I have seen dex use as a antiemetic but it's normally with haloperidol and in pal care. the best antiemetic that covers emotional and phyiscal neasea is ativan(lorazepam) s/l

[augigi, CNS]

What rationale did your CNL give you for not giving dexamethasone on Day 1 of the regime?

What regime were they planning - radiation on Day 2... when was the first dex dose due?