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The flashcards below were created by user
giddyupp
on FreezingBlue Flashcards.
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What is the pathophysiology of Chemotherapy Induced N/V (CINV)?
- the vomiting center in the medulla receives impulses from the Chemoreceptor Trigger Zone, cerebral cortex and afferents from the pharynx and GI tract
- cytotoxic agents (and pregnancy)stimulate vomiting through the CTZ
- Many neurotransmitters (5-HT, H, etc) block this receptor to stop N/V
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Which chemo agents have the most emetogenic potential?
- Cisplatin
- Cyclophosphamide
- Doxorubicin
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Which chemo agents have delayed N/V potential?
- Cisplatin
- Cyclophosphamide
- Carboplatin
- Doxorubicin
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What is the tx for a moderately or highly emetogenic regimen?
- Benzodiazepine for anxiety N/V
- 5-HT3 antagonist + Dexamethasone + Aprepitant on Day 1
- Aprepitant on days 2 and 3
- Dexamethasone on days 3 and 4
- PRN agent for breakthrough N/V
- H2-blocker or PPI
- lifestyle measures
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What is the tx for a low emetogenic regimen?
- Benzodiazepine for anxiety N/V
- Dexamethasone or Metoclopromide
- PRN agent for breakthrough N/V
- H2-blocker or PPI
- lifestyle measures
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What is the tx for a minimally emetogenic regimen?
- Benzodiazepine for anxiety N/V
- No antiemetic, unless risk factors are present
- PRN agent for breakthrough N/V
- H2-Blocker or PPI
- lifestyle measures
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What are the 5-HT3 antagonists used for antiemetics?
- Ondansetron
- Granisetron
- Dolasetron
- Palonesetron (40hr half life = good for acute and delayed N/V)
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What are the NK1 receptor antagonists used for antiemetics?
- Aprepitant
- Fosaprepitant
- For acute AND delayed phases
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What are the PRN agents used for breakthrough N/V?
- Metoclopromide
- Prochlorperazine
- Promethazine
- Droperidol
- Dronabinol
- Nabilone
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What is the MOA of 5-HT3 antagonists?
selectively block 5-HT3 receptors in the GI tract and visceral afferent nerves
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What is the MOA of corticosteroids as antiemetics?
unknown
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What is the MOA of NK1 receptor antagonists as antiemetics?
binds to neurokinin receptor, inhibiting substance P (implicated in emesis)
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What is the MOA of most of the PRN antiemetics?
dopamine receptor blockade in the CTZ
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What is the MOA of cannabinoids as PRn antiemetics?
unknown
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What are the SE of the 5-HT3 antagonists?
- HA
- Constipation
- mild transaminase increase
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What are the SE of corticosteroids as antiemetics?
- mood changes
- increased appetite
- sense of well being
- psychosis
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What are the SE of NK1 antagonists as antiemetics?
- fatigue
- HA
- hiccups
- constipation
- anorexia
- DI
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What are the SE of Metoclopromide PRN antiemesis?
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What are the SE of Prochlorperazine and Promethazine PRN antiemesis?
- EPSE
- sedation
- anticholinergic effects
- hypotension
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What are the SE of Droperidol PRN antiemesis?
- Akathisia
- Dystonic rxns
- sedation
- hypotension
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What are the SE of cannabinoid PRN antiemesis?
- sedation
- dry mouth
- hunger
- orthostatic hypotension
- tachycardia
- ataxia
- dizziness
- euphoria
- dysphoria
- memory loss
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