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444-Oncology and Neurology > Antineoplastic Induced N/V > Flashcards

Antineoplastic Induced N/V Flashcards

1
Q

the vomiting center sends efferent impulses to the _____, ___, ____, ____

A

salivation center, abdominal muscles, stomach, esophagus

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2
Q

where does the CTZ lie

A

outside the BBB in area postrema of the 4th ventricle

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3
Q

what are the 2 principle neuroreceptors involved in nausea and vomiting

A

dopamine and 5HT

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4
Q

what are the 6 nonprinciple neuroreceptors involved in N/V

A

ACh, corticosteroid, histamine, CB, opioid, NK1

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5
Q

acute AINV occurs within

A

24hrs of chemo

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6
Q

acute AINV peaks at

A

5-6hrs

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7
Q

acute AINV resolves in

A

24hrs

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8
Q

delayed AINV occurs ____

A

24hrs or more after chemo

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9
Q

delayed AINV peaks at _____ and resolves by _____

A

peaks 48-72hrs
lasts 6-7 days

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10
Q

breakthrough AINV is N/V that occurs

A

despite appropriate AINV prophylactic therapy

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11
Q

what type of AINV requires rescue therapy

A

breakthrough therapy

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12
Q

what is a conditioned response that occurs before pts receive their next chemo cycle

A

anticipatory AINV

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13
Q

what is refractory AINV

A

NV that occurs in subsequent cycles where antiemetic prophylaxis and rescue agents have failed in earlier cycles

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14
Q

cisplatin emetic risk

A

high

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15
Q

dacarbazine emetic risk

A

high

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16
Q

anthracycline and cyclophosphamide emetic risk

A

high

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17
Q

carboplatin emetic risk

A

mod

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18
Q

oxaliplatin emetic risk

A

mod

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19
Q

what are some high emetic IV antineoplastics

A

cisplatin
anthracycline + cyclophosphamide
dacarbazine

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20
Q

what are some mod emetic IV antineoplastics

A

carboplatin, oxaliplatn

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21
Q

what increases your risk for AINV

A

female
hx of motion sickness
hx morning sickness
hx AINV

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22
Q

what lowers your risk of AINV

A

> 50yrs
high alcohol consumption

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23
Q

which is easier to treat? vomiting or nausea

A

vomiting

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24
Q

which is easier? to prevent AINV or to treat it

A

prevent

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25
Q

what generation are ondansetron and granisetron

A

both first gen

26
Q

what gen is palonosetron

A

2nd gen

27
Q

5HT3RA side effects

A

constipation
QT prolongation

28
Q

which of the following is not used for delayed AINV
1. 5HT3RA
2. NK1RA
3. olanzapine
4. dexamethasone

A

1- acute only

29
Q

NK1ra SEs

A

headaches

30
Q

NK1RAs interact with

A

CYP3A4, 2C9, dex, warfarin, OCs

31
Q

olanzapine AEs

A

sedation, EPS, orthostatic hypotension, QT interval prolongation

32
Q

dexamethasone SEs

A

sleep disturbances
BG changes
mood changes
dyspepsia

33
Q

list the meds included in IV high emetic chemo and how often they’re included

A

5HTRAs always
NK1RA usually
olanzapine sometimes
dex usually

3-4 drugs

34
Q

list the meds included in IV med emetic chemo and how often they’re included

A

5HTRAs always
NK1RA sometimes
olanzapine rarely
dex usually

2-3 drugs

35
Q

when should a pt receive 3 antiemetics for a IV-MEC chemo

A

if using oxaliplatin or carboplatin

36
Q

list the meds included in IV -LEC emetic chemo and how often they’re included

A

5HT3RA usually
dex sometimes
1-2 drugs

37
Q

what is the usual dex dose for AINV

A

8-12mg 30-60min pre (8 for LEC)
might have 8mg f2-3d post if mid-high

38
Q

what is the usual dose for ondansetron for AINV

A

8mg

39
Q

what is the usual dose for granisetron for AINV

A

2mg

40
Q

what is the usual dose for palonosetron fro AINV

A

0.5mg

41
Q

what is the usual dose for aprepitant

A

125mg

42
Q

what is the usual dose for netupitant

A

300mg

43
Q

wha tis the usual dose for olanzapine

A

5-10mg f4d

44
Q

list the meds included in PO-HEC/MEC emetic chemo and how often they’re included

A

5HT3RA always included
dex sometimes included

45
Q

list the meds included in PO-LEC emetic chemo and how often they’re included

A

individualize decision on 5HT3RA
if pt has no AINV for the first 1-2 cycles = can stop 5HT3RA

46
Q

nonpharm measures for breakthrough AINV

A

eat smaller more frequent meals
drink fluids 30 min before food instead of with
choose foods that are easy on the stomach
eat foods at room temp + avoid mixing hot and cold food
avoid foods with strong smell

47
Q

3 pharm choices for breakthrough AINV

A

metoclopramide
prochlorperazine
olanzapine

48
Q

metoclopramide MOA

A

blocks dopamine and 5HT3 receptors on the CTZ

49
Q

metoclopramide AEs

A

drowsiness, dystonia/ TD, diarrhea

50
Q

metoclopramide DIs

A

olanzapine and prochlorperazine

51
Q

prochlorperazine MOA

A

blocks dopamine receptors in CTZ/brain

52
Q

prochlorperazine AEs

A

constipation, xerostomia, drowsiness, EPS

53
Q

prochlorperazine DIs

A

caution with olanzapine and other anti-ACh due to fall risk, seizures, and CNS depression

54
Q

olanzapine MOA

A

5HT, dopamine, H, ACh receptor antagonists

55
Q

olanzapine AEs

A

sedation, orthostatic hypotension, EPS like sx, caution in elderly

56
Q

what is NMS

A

life threatening neuro emergency- sx of mental status change, rigidity, fever

57
Q

nonpharm measures for anticipatory AINV

A

-behavioral therapy
-acupuncture or acupressure
-prevention is key- optimal prophylaxis critical

58
Q

pharm measures for anticipatory AINV

A

-Anxiolytics
-Lorazepam 0.5-1mg po/sl night before chemo, repeat 1-2hrs pre chemo
Don’t drive to chemo

59
Q

what can you do for refractory AINV

A

escalate prophylactic regimen
cannabinoids
other agents like haloperidol, scopolamine, H2 antagonists (if GERD element)

60
Q

what role does cannabis play in AINV

A

small role in breakthrough- second line
mod role in refractory

61
Q

usual dose of cananbinoids for AINV

A

nabilone 1-2mg PO BID prn

444-Oncology and Neurology (22 decks)

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