Emesis

Question 1

Complications of Emesis

Answer 1

o	Dehydration
o	Electrolyte and acid-base imbalance
o	Nutrient depletion – Weight loss
o	Declined quality of life
o	Declined performance status
o	Poor compliance with chemotherapy – May result in failure of chemotherapy

Question 2

Neurotransmitters in Emesis

Answer 2

o Serotonin Type 3 (5HT-3)
o Dopamine Type 2 (D2)
o Neurokinin (NK1)

Question 3

Define Acute Emesis

Answer 3

within 0-24 hours of chemo

Question 4

Define Delayed Emesis

Answer 4

Begins 24 hours after chemo and can last up to 5 days

Question 5

Define Anticpatory Emesis

Answer 5

Learned response to chemo; has to do more with cortex

Question 6

Define Breakthrough Emesis

Answer 6

N/V through prophylaxis

Question 7

Emesis Risk Factors

Answer 7

o Intrinsic emetogenicity of chemotherapy
o Combination of chemotherapy
o Dose of the drug
o Rate of administration
o Younger patients**
o Women > Men**
o Heavy alcohol associated with reduced risk**

Question 8

Metoclopramide MOA

Answer 8

 Block dopamine receptors at the CTZ
 Prokinetic effect by increasing gut motility
 Serotonin receptor antagonist at the higher doses

Question 9

Metoclopramide ADR

Answer 9

Diarrhea, EPS and sedation

Question 10

Metoclopramide Use

Answer 10

Acute and delayed

Question 11

Phenothiazine MOA

Answer 11

Block dopamine receptor at CTZ

Question 12

Phenothiazine ADR

Answer 12

Sedation
Hypotension
EPS

Question 13

Phenothiazine Drugs

Answer 13

Prochloperazine and promethazine

Question 14

Butyrophenones MOA

Answer 14

Block dopamine receptor

Question 15

Butyrophenones ADR

Answer 15

Sedation
Hypotension
EPS

Question 16

Butyrophenone Drugs

Answer 16

Haloperiodol

Droperidol

Question 17

Canabinoids MOA

Answer 17

Unknown

Question 18

Canabinoids ADR

Answer 18

Sedation
Euphoria
Hypothension
Dry mouth
Disorientation

Question 19

Canabinoids Drugs

Answer 19

Dronabinol

Nabilone

Question 20

Benzodizipines MOA in Antegrade Amnesia

Answer 20

• Works by preventing any short-term memory so helps patients handling traumatic events by not remembering it

Question 21

Benzodiazipines ADR

Answer 21

Hypotension
Amnesia
Sedation

Question 22

Corticosteroids MOA

Answer 22

PG blocking action

Changes in cellular permeability

Question 23

Corticoteroid ADRs

Answer 23

 Minimal with short duration (less than 5 days)
 May include euphoria, anxiety, insomnia (take AM), fluid retention, hyperglycemia (induces gluconeogenesis), GI upset
 Demargination

Question 24

Define Demargination

Answer 24

• Signal sent to bone marrow to make bands/baby neutrophils
• Segs are the first line of defense. These are typically attached to the blood vessels, go into the blood and get to the site
• When giving steroids, the segs get detached and come available in the blood = demargination

Question 25

5HT3 Receptor Antagonists MOA

Answer 25

 Central serotonin receptor antagonism |  Peripheral serotonin receptor antagonism

Question 26

5HT3 Receptor Antagonists ADR

Answer 26

(pretty well tolerated): headache, transient transaminase elevations, constipation, hiccups

Question 27

5HT3 Receptor Antagonists General

Answer 27

Oral and IV are equal Whole class has similar efficacy SHORT ACTING EX: ondansatron (all end in setron)

Question 28

Palonosetron Use, half-life, ADR, dosing

Answer 28

Use: moderate or highly emetogenic chemotherapy Longgggg half-life 40 hours ADR: headache, constipation, prolonged QT SHOULD NOT DO ANOTHER DOSE FOR 7 DAYS

Question 29

Substance P/Neurokinin 1 Receptor Antagonists Use

Answer 29

Prevention of moderate or high chemotherapy regimens | All end in pitant

Question 30

Substance P/Neurokinin 1 Receptor Antagonists ADRs

Answer 30

``` Tiredness Nausea Hiccups Constipation or diarrhea Loss of appetite Elevated LFTs ```

Question 31

Aprepitant Dosing

Answer 31

Day 1: Aprepitant 125 mg PO, dexamethasone 12 mg PO/IV, and 5HT3 antgonists PO/IV Day 2-3: aprepitant 80 mg PO and dexamethasone 8 mg PO Day 4: dexamethasone 8 mg PO

Question 32

Olanzapine Brand Class and MOA

Answer 32

Zyprexa Thiobenzodiazepine Potent antagonists of 5HT3A/2C, dopamine, histamine and alpha 1 adrenergic

Question 33

Olanzapine Use

Answer 33

Moderate-severe N/V | Prevention and breakthrough emesis

Question 34

Olanzapine Black Box Warning

Answer 34

* Death in patients with dementia-related psychosis * Type II diabetes and hyperglycemia * Life threatening arrhythmias * EPS

Question 35

What Drugs cause Delayed Emesis?

Answer 35

Cisplatin Anthracyclines Cyclophosphamide Carboplatin

Question 36

Prevention Regimen in High Risk Acute

Answer 36

Start Day 1 1. Aprepitant 125 mg + Ondansatron (5HT3) + dexamethasone (12 mg) 2. Olanzapine + Palonosetron + dexamethasone

Question 37

Prevention Regimen in High Risk Delayed

Answer 37

Start Day 2-3 1. Aprepitant + dexamethasone 2. Olanzapine

Question 38

Prevention Regimen in Moderate Risk Acute

Answer 38

Palonosetron + Dexamethasone +/- aprepitant

Question 39

Prevention Regimen in Moderate Risk Delayed

Answer 39

Dexamethasone Metoclopramide or 5HT3 Olanzapine

Question 40

Prevention Regimen in Low Risk Acute

Answer 40

Dexamethasone, prochloperazine, metoclopramide or short acting 5HT3

Question 41

Prevention Regimen in Minical Risk

Answer 41

PRN antiemetics no scheduled

Question 42

Prophylaxis before Chemotherapy?

Answer 42

5HT3 short acting (ondansetron or palonosetron)

Question 43

Treatment of Anticipatory Emesis

Answer 43

Lorazepam Alprazolam (benzodiazepines)

Question 44

Treatment of Breakthrough Emesis

Answer 44

Prochloperazine --> 5HT3 --> dexamethasone