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Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including:
-Nausea and vomiting
Question:
Per NCCN guidelines, a common 5 drug CINV regimen would include 5HT, NK1, Steroid, Lorazepam, H2A or PPI.
What is the role of the PPI or H2A in regimen?
Consider using a histamine-2 blocker or proton pump inhibitor (PPI) to prevent dyspepsia which is heartburn or impaired digestion.
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OBJECTIVE: Recommend appropriate pharmacotherapy for managing MYELOSUPPRESSION/BONE SUPPRESION (common chemotherapy complication)
-Myelosuppression and appropriate use of growth factors
Question:
Ditto
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Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including:
-Infection
Ditto
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Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including:
-Anemia and fatigue
Ditto
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Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including:
-Cardiotoxicity
Ditto
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Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including:
-Extravasation injury
Ditto
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Recommend appropriate pharmacotherapy for managing cancer-related pain
Ditto
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Recommend appropriate pharmacotherapy for managing oncologic emergencies including:
-Hypercalcemia
Ditto
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Recommend appropriate pharmacotherapy for managing oncologic emergencies including:
-Tumor lysis syndrome
Ditto
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Recommend appropriate pharmacotherapy for managing oncologic emergencies including:
-Spinal cord compression
Ditto
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Vomiting (emesis) is the ejection or expulsion of gastric contents through the mouth.
Acute onset: Occurs 0–24 hours after chemotherapy administration and commonly resolves within
24 hours (intensity peaks after 5–6 hours)
Whats chemo agent causes delayed onset N/V as per Chemo?
- Delayed onset: Occurs more than 24 hours after chemotherapy administration
- Delayed symptoms are best described with cisplatin, although they are commonly reported in association with other agents as well (carboplatin and/or doxorubicin)
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Radiation therapy can also cause nausea and vomiting. Why type of radiation can be classified as Highly Emetogenic?
- a. Mildly emetogenic—Radiation to the head and neck or to the extremities
- b. Moderately emetogenic—Radiation to the upper abdomen or pelvis or craniospinal radiation
- c. Highly emetogenic—Total body irradiation, total nodal irradiation, and upper-half-body irradiation
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Recommend a CINV regimen for Highly emetogenic agent?
- The most common antiemetic regimen for highly emetogenic chemotherapy/radiation is the combination of
- -Neurokinin 1 (NK1) receptor antagonist (Aprepitant/Fosaprepitant)
- -Serotonin receptor antagonist-Ondansetron etc
- -Corticosteroid: Dexamethasone
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There are 10 Chemotherapy agents that are listed as highly Emetogenic.
List the 3 (Three) that start with "C"
- Carmustine > 250mg
- Cisplatin-also causes delayed n/v
- Cyclosphosphamide >1500mg
- A/C-Doxorubicin with Cyclophosphamide
Dacarbazine, Doxorubicin >60mg, Ifosfamide >2000mg, Mechlorethamine, Streptozosin
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OBJECTIVE:
Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
Question:
What is the appropriate three drug antiemetic regimen for Highly/moderately emetogenic chemotherapy or radiation?
- The most common antiemetic regimen for highly emetogenic chemotherapy/radiation is the combination:
- Serotonin receptor antagonist: eg Ondansetron, palonosetron
- Neurokinin 1 (NK1) antagonist: Aprepitant 125mg/80mg/80mg; Fosaprepitant 150mg
- Corticosteroid: Dexamethasone or methylprednisolone
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OBJECTIVE:Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
Question:
Considering the 3-drug regimen for Hughly/moderately emetogenic CINV, Which serotonin receptor antagonist does the NCCN guideline recommend and why?
- Palonosetron is indicated for the prevention of acute CINV for highly emetogenic chemotherapy and acute and delayed CINV for moderately emetogenic chemotherapy
- Dose: 0.25 mg IV push 30 minutes before chemotherapy administration
- Has the Longest Half-Life (40 Hours)
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OBJ: Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
Question:
What are the class side effects of the Serotonin-3 (5-HT3) receptor antagonists (dolasetron, granisetron, ondansetron, and palonosetron)
Serotonin-3 (5-HT3) receptor antagonists (dolasetron, granisetron, ondansetron, and palonosetron)
- a. Mechanism of action (MOA): Block serotonin receptors peripherally in the gastrointestinal tract and centrally in the medulla
- b. Adverse events: Headache and constipation, occurring in 10%–15% of patients. May increase liver function tests and cause QT prolongation
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OBJ: Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
Question:
Which of the several properties; make lorazepam useful in combination with or as an adjunct to other antiemetics
- Benzodiazepines (lorazepam)
- a. Lorazepam as a single agent has minimal antiemetic activity.
- i. Anterograde amnesia helps prevent anticipatory nausea and vomiting. Anticipatory vomiting (or nausea) is triggered by sights, smells, or sounds and is a conditioned response; it is more likely to occur in patients whose previous postchemotherapy nausea/vomiting was not well controlled.
- This is different from delayed onset CINV caused by Cisplatin, Carboplatin and Doxorubicin.
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Olanzapine is approved by the U.S. Food and Drug Administration (FDA) for the treatment of schizophrenia and bipolar disorder, this thienobenzodiazepine is used off-label as an alternative agent for the prevention of nausea/vomiting in highly emetogenic regimens and may be used as an option for breakthrough nausea/vomiting
Question:
List the the complete regimen on day 1 for a chemo Pt with or without olanzapine?
- With Olanzapine(doesnt contain NK-1)
- Palonosetron 0.25 mg IV day 1
- Dexamethasone 20 mg IV day 1
- Olanzapine 10 mg PO day 1
- ± Lorazepam
- ± H-2 blocker or PPI
- Without Olanzapine(contains NK-1)
- Palonosetron 0.25 mg IV day 1
- Aprepitant 125mg on day 1
- Dexamethasone 20 mg IV day 1
- ± Lorazepam
- ± H-2 blocker or PPI
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OBJECTIVE:Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
Question:What agents do you use for mildly emetogenic CINV?
- Single-agents of:
- Phenothiazine (Promethazine, Prochloperazine, Chlorpromazine)
- Butyrophenone (haloperidol, droperidol)
- Steroids (Dexamethasone, Methylpred)
- are used for mildly to moderately emetogenic regimens and are given on either a scheduled or an "as-needed" basis for prolonged symptoms (i.e., breakthrough symptoms)
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OBJECTIVE:Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
Question:Which agents do you use for CINV when everything else has failed and refractory?
- Cannabinoids (dronabinol, nabilone)
- are generally used after other regimens have failed or to stimulate appetite
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