He encontrado que alguna farmacia puede tener existencias limitadas de ciertos medicamentos, mientras que otras pueden tener casi cualquier formato que se le ocurra y el habitual de dosis habitualidad apareció. En resumen, siempre se contiene el almacén de corroborar. Al mismo tiempo que el producto que más que gustaba ha resultado no estaba disponible en stock otro distinto por las Buenas costumbres también debe buscarse jefe no asн parezca. Por eso es importante disponer de un Plan B para actuar cuandod ello no ocurra. Ventaja de tomar un genérico en lugar de Asix Un genérico es más barato que el nombre de marca Uno de los mayores incentivos para someterse al Dónde comprar Lasix genérico en lugar de pagar la marca es que usted puede obtener un ahorrando importantes Lasix genérico. Por lo tanto, un Lasix genérico es en general mucho más barato que el homólogo de marca, así que una denominación genérica se hace posible para las personas que usan este medicamento con frecuencia. Un ejemplo: La compra de lurosemida en lugar de Lasix es una considerable ahorro para el presupuesto mensual de medicamentos.

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ACUTE EMESIS PROPHYLAXIS1-4
Minimally Emetogenic Regimes (< 10%)
• Prophylactic antiemetic therapy generally is not • If the patient experiences nausea or vomiting, use prophylactic therapy prior to subsequent • Patients who do not respond to a 2-drug combination may benefit from the following:  One of the following regimens is recommended:  Dexamethasone 8 to 20 mg PO, given 30  A corticosteroid, dopamine antagonist, and  Addition of a neurokinin antagonist to their diphenhydramine 25 to 50 mg PO if needed, Mildly Emetogenic Regimens (10% to 30%)
diphenhydramine 25 to 50 mg PO if needed, • For most patients, prophylactic antiemetic therapy, particularly with a serotonin antagonist, generally is diphenhydramine 25 to 50 mg PO if needed, • If needed, one of the following regimens may be • If patient still experiences significant nausea  Dexamethasone 8 to 20 mg PO, given 30 or vomiting, add an agent from a different diphenhydramine 25 to 50 mg PO if needed,  The following regimens are recommended:  Patients who received a corticosteroid only: diphenhydramine 25 to 50 mg PO if needed, antagonist only: Add a corticosteroid.
 Patients who received a corticosteroid and diphenhydramine 25 to 50 mg PO if needed, dopamine antagonist: Substitute a serotonin antagonist for the dopamine antagonist.
• If patient still experiences significant nausea  If a corticosteroid and dopamine antagonist or vomiting, add an agent from a different combination is not effective, a serotonin antagonist and corticosteroid combination may  The following regimens are recommended:  The following regimens are recommended:  Patients who received a corticosteroid only: antagonist only: Add a corticosteroid.
 Patients who received a corticosteroid and dopamine antagonist: Substitute a serotonin antagonist for the dopamine antagonist.
 If a corticosteroid and dopamine antagonist combination is not effective, a serotonin antagonist and corticosteroid combination may  The following regimens are recommended: • Antiemetic therapy should continue for at least 3  Prolonged (more than 24 hours) use of serotonin antagonists is NOT recommended.6
 A corticosteroid or corticosteroid and dopamine antagonist combination is recommended for  One of the following regimens is suggested:  Dexamethasone 4 mg PO twice a day for 3 days ± metoclopramide 0.5 to 2 mg/kg PO every 4 to 6 hours ± diphenhydramine 25 to • Patients who do not respond to a 2-drug 50 mg PO every 6 hours if needed, starting combination may benefit from the following:  A corticosteroid, dopamine antagonist, and  Dexamethasone 4 mg PO twice a day for 3 days ± prochlorperazine 10 mg PO every 4  Addition of a neurokinin antagonist to their to 6 hours ± diphenhydramine 25 to 50 mg PO every 6 hours if needed, starting on day 2 of chemotherapy Moderately Emetogenic Regimens (30% to 90%)
 Dexamethasone 4 mg PO twice a day for 3 • Prophylactic antiemetic therapy with a serotonin days ± promethazine 25 to 50 mg PO every antagonist is recommended but may not be 4 to 6 hours ± diphenhydramine 25 to 50 mg PO every 6 hours if needed, starting on day 2 • One of the following regimens may be given 30  If a neurokinin antagonist is used, one of the dexamethasone 20 mg PO, given 30 minutes  Ondansetron 16 to 24 mg, dexamethasone 12 mg, and aprepitant 125 mg given PO 30  Granisetron 1 to 2 mg PO and dexamethasone  Granisetron 1 to 2 mg, dexamethasone 12  Dolasetron 100 mg PO and dexamethasone 20 mg PO, given 30 minutes before chemotherapy  Dolasetron 100 mg, dexamethasone 12 mg,  Palonosetron 0.25 mg IV and dexamethasone and aprepitant 125 mg given PO 30 minutes  Palonosetron 0.25 mg IV (day 1 only),  Use of a neurokinin (NK ) antagonist is recommended for regimens that include both  The following regimens are suggested:  Patients who experience significant nausea should receive an agent from a different  Substituting granisetron for ondansetron been shown to be effective and is NOT
A Guide to Combination Cancer Chemotherapy Regimens Highly Emetogenic Regimes (>90%)
if needed, ± diphenhydramine 25 to 50 mg PO  Prochlorperazine 25 mg rectally every 4 to 6 hours if needed, ± diphenhydramine 25 to 50  Promethazine 25 to 50 mg PO every 4 to 6 hours if needed, ± diphenhydramine 25 to 50  ± a dopamine or serotonin antagonist SPECIAL CONSIDERATIONS
Serotonin (5HT ) antagonists
 Aprepitant 125 mg, dexamethasone 12 mg, • Meta-analysis recommends against use of these and ondansetron 16 to 24 mg PO 30 minutes • There is no benefit to using granisetron in patients  Aprepitant 125 mg, dexamethasone 12 mg, and granisetron 2 mg PO 30 minutes before • High-dose granisetron (3 mg IV or 40 to 240 mcg/kg)7-11 for breakthrough nausea provides no mg, and dolasetron 100 to 200 mg PO 30 minutes before chemotherapy Carboplatin
 Aprepitant 125 mg, dexamethasone 12 mg, • Causes delayed nausea or emesis similar to  Mechanism of action and clinical course differ  A neurokinin antagonist and corticosteroid  Urinary 5-hydroxyindole acetic acid (5-HIAA) or neurokinin antagonist, corticosteroid, and appropriate for follow-up therapy. One of the • The clinical course of nausea or vomiting  Reflects this pattern of serotonin release.
 Usually begins 6 to 7 hours after drug  May persist for up to 120 hours.
 Prochlorperazine 10 mg PO every 4 to • Some clinicians divide the daily antiemetic dose into 2 doses on days when carboplatin is administered.
Cisplatin
• Doses > 50 mg/m2 (single dose or cumulative over  Patients with significant nausea or vomiting should receive an agent from a different  Peak severity occurs at 48 to 72 hours after Breakthrough Nausea and Vomiting1-4
 Usually abates between 96 to 168 hours • Patients should have an antiemetic for Cyclophosphamide
• Emesis is often delayed for up to 12 hours after  Metoclopramide 0.5 to 2 mg/kg PO every 4 to drug administration and may persist for up to 120 6 hours if needed, ± diphenhydramine 25 to 50 • Divide the daily antiemetic dose into 2 doses on  Prochlorperazine 10 mg PO every 4 to 6 hours days when cyclophosphamide is administered.
HYDRATION
Carboplatin
• If doses are adjusted for renal function (as in AUC dosing), no prophylactic hydration or diuretic use is Cisplatin
Bleomycin19
• Can cause irreversible kidney damage by acute • Can induce acute hypersensitivity reactions. • Maintain a urine output ≥ 75 to 100 mL/h for several hours before and after each dose. • Numerous hydration and diuretic regimens have • Except possibly the first treatment cycle, diuretics 30 minutes prior to each dose of bleomycin have no benefit over vigorous hydration.
• One suggested regimen is D5W-NS or NS at 250 mL/h for 2 to 4 hours before and after each dose. • Oral hydration regimens are also used, but Docetaxel21,22
increased chloride from IV solutions may offer • Less likely to cause hypersensitivity reactions than • Manufacturer recommends the following:  Intuitively supports their use to prevent  Dexamethasone 8 mg PO twice daily for 3 days  Begin the day before the docetaxel infusion  There is no evidence to recommend diuretics • Some clinicians add a histamine H antagonist ± a Cyclophosphamide
 If used, the following regimen is suggested: • Risk of hemorrhagic cystitis increases with  Cimetidine 300 mg or ranitidine 50 mg  All given IV over 30 minutes prior to • Patients should empty their bladder frequently.
• Hydration reduces the risk of cystitis.
Doxorubicin, Liposome Encapsulated23-26
• Encourage liberal fluid consumption (3 to 4 L/day) • Infusion-related reactions, particularly with the first  Recommended prophylactic medications prior to the first dose, and if necessary, prior to • Cystitis has been reported following a single IV  Hydrocortisone 100 mg IV or dexamethasone
HYPERSENSITIVITY PRECAUTIONS
 Diphenhydramine 25 mg or 50 mg IV
Anthracyclines
 Cimetidine 300 mg or famotidine 20 mg IV
• Daunorubicin/doxorubicin/epirubicin/idarubicin • Can cause acute hypersensitivity reactions Oxaliplatin27-30
• Reactions occur in 5% to 25% of patients.
• Moderate to severe reactions occur in < 1% to 9% • Most reactions occur at or after the seventh to ninth • Lengthening the infusion time to 6 hours may reduce the incidence of hypersensitivity reactions.

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