Chemotherapy Induced Nausea/Vomiting

Question 1

List the complications of nausea/vomiting. (4)

Answer 1

dehydration; electrolyte imbalance; fatigue; depression

Question 2

Definition: a learned response conditioned by previous emetic reactions to chemotherapy

Answer 2

Anticipatory N/V

Question 3

Definition: emetic response occuring within 24 hours of receiving chemotherapy

Answer 3

Acute N/V

Question 4

Definition: emetic response occuring more than 24 hours after last dose of chemotherapy

Answer 4

Delayed N/V

Question 5

Definition: emetic response that occurs even if taking scheduled anti-emetics prior to chemotherapy

Answer 5

Breakthrough N/V

Question 6

Definition: nausea/vomitting that persists while on anti-emetic therapy

Answer 6

Refractory N/V

Question 7

Definition: an inclination to vomit; a feeling in the throat or epigastric region alerting the individual that vomiting may occur

Answer 7

Nausea

Question 8

Definition: labored movement of abdominal and thoracic muscles before vomitting

Answer 8

Wretching

Question 9

Definition: the ejection of gastric contents through the mouth

Answer 9

Vomiting

Question 10

What are the two main targets of anti-emetic medications?

Answer 10

serotonin; substance P

Question 11

Name a highly emetogenic chemotherapy drug.

Answer 11

cisplatin

Question 12

List risk factors for chemotherapy induced nausea/vomiting. (6)

Answer 12

female; younger age; history of motion sickness; history of morning sickness; previous CINV; anxiety/anticipation of nausea

Question 13

Name a factor that can be protective against CINV.

Answer 13

chronic ethanol intake

Question 14

What are some common toxicities of serotonin antagonists? (3)

Answer 14

headache; prolonged QT interval; constipation

Question 15

What are some common toxicities of short-term corticosteroids? (3)

Answer 15

insomnia; increased appetite; hyperglycemia

Question 16

What is the main concern with NK-1 antagonists?

Answer 16

drug interactions - metabolized by CYP3A4

Question 17

What are some common toxicities of phenothiazines? (1)

Answer 17

sedation

Question 18

What are some common toxicities of Benzodiazepines? (2)

Answer 18

sedation; urinary incontinence

Question 19

What are some common toxicities of anticholinergic agents? (4)

Answer 19

salivation; lacrimation; urination; defecation

Question 20

What two medications are always prescribed for a highly emetogenic regimen?

Answer 20

Steroid (dexamethasone) & serotonin antagonist (ondansetron, etc.)

Question 21

How many agents should be included in a highly emetogenic regimen?

Answer 21

3 or 4

Question 22

What agents can be added to a highly emetogenic regimen? (other than the two mainstays of treatment)

Answer 22

NK-1 antagonists (aprepitant) & atypical antipsychotics (olanzapine)

Question 23

How many agents should be included in a moderate emetogenic regimen?

Answer 23

2 or 3

Question 24

How many agents should be included in a low emetogenic regimen?

Answer 24

1

Question 25

What options are there for a low emetogenic regimen? (4)

Answer 25

dexamethasone; metoclopramide; prochlorperazine; 5-HT3 antagonists

Question 26

What can be used to prevent EPS (extra pyrimadal symptoms) due to metoclopramide or prochlorperazine? (2)

Answer 26

benztropine or diphenhydramine

Question 27

What agents can be used for breakthrough N/V? (7)

Answer 27

dopamine receptor antagonists; atypical antipsychotics; phenothiazines; benzodiazepines; serotonin antagonists; steroids; anticholinergics

Question 28

What agents are commonly used for delayed N/V? (3)

Answer 28

dexamethasone; NK-1 antagonist; olanzapine

Question 29

What medication is used to prevent anticipatory N/V?

Answer 29

Lorazepam

Question 30

What agent can be used as preventative therapy for high/moderate emetogenic regimens?

Answer 30

5-HT3 antagonists

Question 31

What agents can be used as preventative therapy for low emetogenic regimens? (3)

Answer 31

metoclopramide; prochlorperazine; 5-HT3 antagonists

Question 32

What agents can you use to prevent radiation induced emesis?

Answer 32

5-HT3 antagonist +/- dexamethasone

Question 33

When should anti-emetics be administered?

Answer 33

5 to 30 minutes prior to chemotherapy

Question 34

What patients should be given PRN anti-emetics to take home after chemotherapy?

Answer 34

ALL OF THEM