Medication recommendations and personal protection for new coronary pneumonia in cancer patients

2

Drug introduction - list of commonly used drugs for symptomatic treatment

Tumors belong to the scope of underlying diseases, and tumor patients often have low immunity and liver and kidney dysfunction due to chemotherapy and immunotherapy
.

For example, in a large number of clinical studies, it has been found that PD-1 treatment will cause adverse reactions above grade 1, 2 and 3, including liver toxicity, skin toxicity, pneumonia, etc^{.
[3, 4].}

The "Guidelines for the Management of Toxicity Related to Immune Checkpoint Inhibitors (2019 Edition)" recorded the occurrence time of immunotherapy-related adverse reactions: 11.
2 weeks for the lungs, 12 to 40 weeks for the kidneys, and 8 to 12 weeks for the liver
.

Cytotoxic drugs such as cyclophosphamide, bleomycin, methotrexate, and rituximab can also induce drug-induced lung injury ^[5,6].

Anthracyclines (doxorubicin) are common cardiotoxic.

Fruquininib and other abnormal liver function can be seen ^[7].

Therefore, when selecting drugs with symptomatic new coronary pneumonia, pay attention to its impact on the patient's liver and kidney function, and it is recommended to consult a doctor/pharmacist
before use.

1.
Fever: acetaminophen is often used to control fever caused by various reasons, mainly metabolized in the liver, prone to drug-induced liver damage, and the amount of use should not exceed 2g
per day.
Ibuprofen is commonly used in the treatment of trauma and joint inflammatory pain while relieving fever, and is not recommended for patients
with heart disease, peptic ulcer and renal insufficiency.
The instructions for the drug Ibuprofen and paracetamol are clearly indicated for the treatment of fever for no more than 3 days
.

Aspirin can be used to relieve pain, fever and redness
.
Oral aspirin can directly irritate the gastric mucosa and cause nausea and vomiting, and it is best to take the drug with food
.
Low-dose aspirin may be considered for primary prevention in individuals at high risk of cardiovascular disease and low bleeding ^{risk [8,9].}

Lung cleansing and detoxification granules are used to feel the epidemic diseases caused by cold and wet epidemic poison, and Xuanlung sepsis particles are used for epidemic diseases
caused by wet poison and depressed lungs.
Xuanlung septic granules have the functions of antiviral infection and regulating the level of inflammatory factors, which can shorten the treatment time of Omicron strain infection and promote the regression of symptoms ^[10].

Lianhua Qingwen has a definite effect and is a necessary drug
for patients with new coronary pneumonia.
However, Lianhua Qingwen granules are composed of a large number of cold medicinal herbs, and it is necessary to pay attention to adverse reactions of the digestive system (diarrhea is not suitable for use), as well as possible symptoms such as decreased white blood cells and abnormal liver function ^[11].

2.
Dry throat soreness: Shufeng Detoxification Capsule has the effects of clearing wind and heat, cooling blood and detoxification, etc.
, showing obvious advantages in inhibiting the growth of Streptococcus pneumoniae and Staphylococcus aureus, and has the effect of inhibiting inflammatory reaction and anti-infection, which can effectively improve clinical symptoms such as sore throat and enhance the body's immune function ^[12].

Diquinonium chloride has a broad-spectrum antimicrobial effect and is effective
against common pathogenic bacterial and fungal infections of the mouth and throat.
Wide range of sterilization, fast action, strong potency, almost no toxicity and irritation
.

Liushen Pill is a classic recipe and a national secret variety
of traditional temperature medicine.
It is composed of 6 flavors of Chinese medicine, such as bezoar, musk, male yellow, toad crisp, ice chips and pearls, which has the effect of cooling and detoxifying, anti-inflammatory and analgesic, and can be used to treat respiratory diseases such as throat wind and throat carbuncle, nameless swelling and ^{poisoning [13]}, containing musk, easy to hurt jin liquid, pregnant women are banned
.

Clear throat drop pills are used for sore throat, dry throat, thirst, have a certain bacteriostatic effect on Staphylococcus aureus and Candida albicans, and have a certain inhibitory effect on coxsackie virus and influenza virus ^[14].

3.
Cough and sputum: bromohexanoine, ambroxol, guaifene, acetylcyste, etc.
, are expectorants, that is, change the viscous components in sputum, reduce the viscosity of sputum, and make sputum easy to cough up
.
When these drugs are used, they should be avoided at the same time as antitussives to avoid thinning sputum blocking the airways
.

Bromhexin is irritating to the mucosa of the gastrointestinal tract, and should be used with caution in patients with gastritis or gastric ulcer, and should be used
under the guidance of a physician in patients with hepatic insufficiency.

The combination of acetylcysteine and nitroglycerin can cause significant hypotension, and the combination of the two drugs should be avoided as much as possible
.

Guaifenether is irritating the gastric mucosa, causing increased secretion of tracheal and bronchial glands, thinning sputum and easy to cough up
.
May cause nausea and vomiting, maintain adequate hydration
during drug therapy.

4.
Dry cough without phlegm: Folke can be classified as a central cough suppressant, less addictive than codeine, and is not recommended for children
.

Dextromethorphan is also a central cough suppressant, without addiction and drug resistance
.
For cough caused by dry cough
, asthma, sore throat, etc.
Taking drugs containing this ingredient in large doses may cause side effects such as brain damage, loss of consciousness, and irregular heartbeat, and need to be treated
correctly.

5.
Runny nose: Chlorpheniramine (aka chlorpheniramine) helps reduce secretions and reduce cough symptoms, so it is recommended as the drug
of choice for the common cold.
However, it has a drowsiness effect, and high-risk workers should be used
with caution.

Loratadine, cetirizine second-generation antihistamines, drowsiness side effects are small
.
It has a fast onset of action and a maintenance time of up to 24 hours, so it only needs to be taken once a day in a small
dose.
However, it is not absolutely free of side effects of drowsiness, so try to avoid working
at height during medication.

6.
Nasal congestion: Xylozolin nasal drops directly act on receptors on small blood vessels of the nasal mucosa to reduce nasal mucosal hyperemia and edema
caused by inflammation.
It takes effect 5~10 minutes after nasal drops, can last 5~6 hours, and can be used for rhinitis
caused by fungal infections.
Patients with coronary heart disease, hypertension, hyperthyroidism, and diabetes should be used
with caution.

7.
Nausea/vomiting: Cinnarizine, Huo Xiang Zhengqi Water/capsules have antiemetic effects
.

Cinnarizine can treat migraine, can cause epigastric discomfort, it is recommended to take it after meals, and the dose
should be adjusted in patients who require hemodialysis.

Hui Xiang Zhengqi water/capsule has the role of detoxifying moisture, regulating qi and relieving qi, because it contains alcohol, so it is forbidden
for those who are allergic to alcohol.
Also avoid taking cephalosporins to avoid disulfiram-like reactions (nausea, chest tightness, dyspnea, and death).

3

Tips for home medication for cancer patients

1.
Do not take medicine
if you have no symptoms.
Antipyretic, cold, cough, and phlegm dissolving drugs cannot prevent diseases, but only relieve symptoms
.
When there are no symptoms, do not take the medicine
blindly.

2.
Do not take
fever-reducing medicine with compound cold medicine.
Antipyretic drugs should not be used at the same time as common cold medicines, nor with some cold medicines, and random mixing will increase the risk of
drug overdose.

3.
Do not use anti-inflammatory drugs
haphazardly.
New crown pneumonia is a viral infection, anti-inflammatory drugs (amoxicillin, cephalosporin, etc.
) are usually for bacterial infections, do not use anti-inflammatory drugs to treat the new crown.

4.
Patients with new coronavirus infected tumors are recommended to postpone anti-tumor treatment, and after the relevant symptoms are completely relieved and the new coronavirus nucleic acid test is negative (2 consecutive times, with an interval of 24 h), restarting anti-tumor therapy can be considered, and factors such as indications, treatment goals and treatment tolerance of anti-tumor treatment can be fully evaluated (evidence level: grade II.
, recommendation level: strong recommendation) ^[15].

。

4

Cancer patients need vaccine protection even more

Current clinical evidence suggests that vaccination against COVID-19 can prevent severe symptoms of the disease and is an important means of reducing virus transmission and infection rates ^[16].

According to the Chinese Expert Consensus on Issues Related to the Protection and Diagnosis and Treatment Management of Solid Tumor Patients during the Novel Coronavirus Pneumonia Epidemic (2022 Edition), cancer patients can be vaccinated without special emergencies ^[15].

Therefore, it is recommended that cancer patients who can be vaccinated choose the right time, sufficient amount, full course of treatment
, and vaccination according to the recommended dose and dose.
The timing of vaccination of patients with tumors during different types of anti-tumor therapy is shown in the figure below:

Patients with tumors with rapid progression and ineffective control of the disease are not recommended to be vaccinated or postponed
.
Whether vaccinated or not, do a good job of protection to minimize the risk
of exposure to the new coronavirus.

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