Sample BCOP Question 1
WW is a 56 year old male with metastatic colon cancer who is starting FOLFIRI (fluorouracil, oxaliplatin, leucovorin). On the first night of chemotherapy, he begins experiencing severe abdominal cramping and diarrhea. Which of the following treatments is most appropriate for WW at this time?
- Octreotide
- Tincture of opium
- Loperamide
- Atropine
Answer: D
Rationale:
- Irinotecan can cause acute or delayed diarrhea. Acute diarrhea occurs immediately after irinotecan administration and is associated with cholinergic symptoms such as abdominal cramping, rhinitis, lacrimation, and salivation. The mean duration of symptoms is 30 minutes, and atropine is the drug of choice. In this situation, WW has acute diarrhea (< 24 hours after irinotecan was given).
- On the other hand, delayed diarrhea occurs more than 24 hours after irinotecan administration, is noncumulative, and occurs at all dose levels.
- Octreotide, tincture of opium and loperamide are inappropriate for WW as they do not have anticholinergic properties and will not relieve his symptoms.
High-Yield Core Concept:
- Irinotecan may cause acute or delayed diarrhea. The immediate onset diarrhea is associated with cholinergic symptoms, and atropine is the drug of choice.
High-Yield Fast Fact(s):
- Risk factors for irinotecan-induced diarrhea include weekly administration, poor performance status, high serum creatinine levels, prior abdominal radiation therapy, low WBC, age over 70 years, Gilbert syndrome, and Crigler-Najjar syndrome type 1.
References:
- J Clin Oncol. 2004 Jul 15;22(14):2918-26.
- Ther Adv Med Oncol. 2010 Jan; 2(1): 51-63.