Anti-emetics

Question 1

Categories of emetoginicity rating

Answer 1

High (cisplatin, cyclophos>1500, dacarbazine, mechlorethamine, streptozocin)
Moderate (azacitidine, carboplatin, cyclophos<1500, cytarabine>100, doxorubicin, epirubicin, idarubicin, ifosfamide, irinotecan, oxaliplatin)
Low (Cytarabine<1000, etoposide, gemcitabine, mtx, paclitaxel)
Minimal (Bleomycin, cetuximab, fludarabine, rituximab, vincristine)

Question 2

Serotonin antagonists

+AE

Answer 2

Ondansetron
Granisetron
Dolasetron
Palonosetron
AEs: headache, constipation, QT prolongation in iv ond and dol

Question 3

Must add ___ to a 5Ht3a

Answer 3

Dexamethasone

Question 4

Serotonin (5HT3) nausea happens

Answer 4

acute
t=0-12 hrs
So treat early!

Question 5

Steroid nausea

Answer 5

during all chemo time

Question 6

NK1 nausea

Answer 6

delayed

t=12+ hrs

Question 7

Serotonin (5HT3) nausea happens

Answer 7

acute
t=0-12 hrs
So treat early!
Dose last 12-24 hours

Question 8

Substance P (SP)

Answer 8

mostly delayed nausea but some acute too

Question 9

When combined, the agent is classified as high risk

Answer 9

Doxorubicin + cyclophosphamide
Treat with triple therapy
NK1a, 5HT3a, corticosteroid

Question 10

Dopamine antagonists

+AEs

Answer 10

Prochlorperazine
Promethazine
Metoclopramide
Haldol Droperidol
Perphenazine, chlorpromazine
Olanzapine
AEs: sedation, EPS movements, dry mouth, QT prolong

Question 11

Olanzapine use

Answer 11

for delayed nausea and vomiting. Different dose than antipsychotic dose.
Has diminished anti-dopaminergic effects

Question 12

Dopamine antagonists
+AEs

Use for BREAKTHROUGH naus

Answer 12

Prochlorperazine (1st choice)
Promethazine (resp depress risk with opioids)
Metoclopramide (use if constipated)
Haldol (2nd choice)
Droperidol
Perphenazine, chlorpromazine
Olanzapine
AEs: sedation, EPS movements, dry mouth, QT prolong

Question 13

Olanzapine use

Answer 13

for delayed nausea and vomiting. Different dose than antipsychotic dose.
Has diminished anti-dopaminergic effects
Use this for anx before a benzo

Question 14

Cannabinoids

Answer 14

Dronabinol

good for nausea but not vomitting

Question 15

Histamine and musc antagonists

Answer 15

diphenhydramine, dimenhydrinate, meclizine, scopalamine

Question 16

Acute high risk

Answer 16

5ht3 + Nk1a + steroids + olanzapine +/- benzo

Question 17

Acute moderate risk

Answer 17

Carboplatin AUC>4: 5ht3 + Nk1a + steroids

Others: 5ht3 + steroids +/- benzo

Question 18

Acute low risk

Answer 18

5ht3 + dexamethasone

Question 19

Acute minimal risk

Answer 19

just prns

Question 20

Anticipatory n/v

Answer 20

Good control in first round
Calming music
Muted colors in office
Benzo (lorazepam, alprazolam) = amnesia

Question 21

Anticipatory n/v

Answer 21

Good control in first round
Calming music
Muted colors in office
Benzo (lorazepam, alprazolam) = amnesia

Question 22

Delayed High risk

Answer 22

5ht3 + Nk1a + dexameth on Day 1 and dexameth + olanzapine days 2-4

Question 23

Delayed moderate risk

Answer 23

Dexameth days 2-3

Question 24

Delayed classes at risk

Answer 24

platinum, cyclophos and ifosomide, anthracyclines, nitrogen mustards

Question 25

Rescue nausea agents

Answer 25

Something that hasn’t already been used in patient
Schedule..then prn once controlled
Assess for the cause

Question 26

Vomitting algorithm

Answer 26

Aloxi/Zofran
Prochlorperazine -> Haldol
Olanzapine
Scopalamine (8 hrs to work)

Question 27

Naus algorithm

Answer 27

Aloxi/Zofran
Prochlorperazine -> Haldol
Scopalamine
Dronabinol
Olanzapine