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Therapeutics P3 Spring > Chemo Induced Nausea/Vomiting > Flashcards

Chemo Induced Nausea/Vomiting Flashcards

1
Q

Acute Chemo-induced Nausea and Vomiting (CINV)

A

CINV occurring in the first 24h after starting chemo

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2
Q

Delayed CINV

A

CINV occurring from 24h - several (2-5) days after chemo

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3
Q

Breakthrough CINV

A

CINV occurring despite appropriate preventative treatment

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4
Q

Anticipatory CINV

A

CINV occurring before a treatment as a conditioned response to the occurrence of CINV in previous cycle

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5
Q

Refractory CINV

A

CINV recurring in subsequent cycles of therapy, excluding anticipatory CINV

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6
Q

CINV occurs due to communication between which 3 main neurotransmitters/receptors in the CNS and GI tract

A

5-HT3
Substance P and NK-1 receptor
Dopamine

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7
Q

CINV Peripheral pathway

A

5-HT3 moderated
originates in GI tract
Mostly associated with acute emesis

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8
Q

CINV Central pathway

A

NK-1 receptor mediated
occurs mostly in the brain
mostly associated with delayed CINV

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9
Q

Lifestyle modifications to manage CINV

A

small frequent meals
eating meals at room temp

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10
Q

CINV risk factors

A

Age < 50 yrs
female
emetic potential of chemo
little or no previous alcohol use
Hx of CINV or prone to motion sickness
Emesis during pregnancy

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11
Q

Prevention for high risk IV cancer regimens

A

Option 1 (preferred)
- day 1: Olanzapine, Dexamethasone, NK1-RA, 5-HT3RA
- day 2-4: Olanzapine, Dexamethasone
Option 2
- day 1: Olanzapine, Dexamethasone, Palonosetron
- days 2-4: Olanzapine
Option 3:
- day 1: Dexamethasone, NK1 RA, 5-HT3 RA
- days 2-4: Dexamethasone

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12
Q

Should aprepitant IV ever be given on days 2-3?

A

NO

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13
Q

Should aprepitant PO ever be given on days 2-3?

A

only if aprepitant was given day 1

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14
Q

Prevention for moderate risk IV cancer regimens

A

Option 1:
- day 1: Dexamethasone, 5-HT3 RA
- day 2-3: Dexamethasone OR 5-HT3 RA
Option 2:
- day 1: Olanzapine, Dexamethasone, Palonosetron
- day 2-3: Olanzapine
Option 3:
- day 1: NK1 RA, dexamethasone, 5-HT3 RA
- day 2-3: Aprepitant +/- Dexamethasone

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15
Q

Agents for low emetic risk IV cancer regimens

A

one of the following:
- Dexamethasone
- Metoclopramide
- Prochlorperazine
- 5-HT3 RA

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16
Q

CINV prevention for minimal emetic risk IV cancer agents

A

no prophylaxis recommended

17
Q

CINV prevention for high -moderate risk PO anticancer regimens

A

5-HT3 RA

18
Q

CINV prevention for low-minimal risk PO anticancer regimens

A

PRN recommended

19
Q

Breakthrough CINV treatment

A
  • Add one agent from a different drug class to the current regimen
  • Consider regular admin rather than PRN
  • Consider antacid therapy if pt has dyspepsia

Agents:
- olanzapine
- lorazepam (good for anx related sx)
- dronabinol
- 5HT3 RA (not palonosetron: long t1/2)
- prochlorperazine
- dexamethasone
- metoclopramide
- scopolamine

20
Q

Anticipatory emesis treatment

A

Avoid strong smells
Lorazepam
Acupuncture
Behavioral therapy

21
Q

Dexamethasone

A

MOA: unknown
ADE:
- insomnia (admin in AM)
- dyspepsia (take with food / add H2RA or PPI)
- hyperglycemia
- HTN

22
Q

5-HT3 RA

A

MOA: blocks serotonin both peripherally (GI) and centrally (medulla)
ADE:
- HA
- Constipation
QTc prolongation

1st gen: Ondansetron, Granisetron
- good for acute CINV
- short acting

2nd gen: Palonosetron
- good for acute and delayed CINV
- long acting
- never use for breakthrough CINV

23
Q

NK1-RA

A

MOA: inhibits substance P/NK1
- augments 5HT3 RA and dexamethasone antiemetic activity
Only used for preventing CINV, not treatment
Agents:
- aprepitant
- fosapretant
- rolapitant (long t1/2, should not be administered < 2 week intervals)
- fosnetupitant
- netupitant

DDI:
- inhibit CYP3A4 and CYP2C9 (decrease dexamethasone dose to 8mg on days 2-4)

ADE:
- fatigue
- GI upset
- HA
- hiccups

24
Q

Olanzapine

A

MOA: blocks dopamine, serotonin, muscarinic and histamine receptors
used for prevention and breakthrough
ADE:
- Sedation!!! (admin at bedtime, lower doses in elderly)
- hyperglycemia
- fatigue
- QTc prolongation

25
Q

Dopamine antagonists

A

MOA: antagonize dopamine in chemoreceptor trigger zone
- useful for breakthrough CINV
Agents:
- prochlorperazine
- metoclopramide
- promethazine
ADE:
- prochlorperazine, promethazine: drowsiness, constipation
- metoclopramide: drowsiness, diarrhea, QTc prolongation, tardive dyskinesia (avoid > 12 weeks use)

prochlorperazine has the lowest QTc risk

26
Q

Benzodiazepines

A

MOA: anxiolytic
- useful for anticipatory CINV or breakthrough CINV with an anxiety component
Agents:
- lorazepam
- alprazolam
admin the night or morning before therapy (or both)
ADE:
- sedation
- dizziness

27
Q

Cannabinoids

A

MOA: CB1 antagonism suppresses vomiting + indirect activation of 5HT1a in raphe nucleus
Rarely used; only indicated for refractory disease
Agents:
- dronabinol
ADE:
- sedation
- euphoria, hallucinations
- palpitations
- flushing
- cough

28
Q

Scopolamine

A

MOA: anticholinergic
only for breakthrough disease
ADE:
- dry mouth
- somnolence
- blurred vision

Therapeutics P3 Spring (32 decks)

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