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Chemotherapy Induced Nausea and Vomiting
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What is the pathophysiology of Chemotherapy Induced N/V (CINV)?
the vomiting center in the medulla receives impulses from the Chemoreceptor Trigger Zone, cerebral cortex and afferents from the pharynx and GI tract
cytotoxic agents (and pregnancy)stimulate vomiting through the CTZ
Many neurotransmitters (5-HT, H, etc) block this receptor to stop N/V
Which chemo agents have the most emetogenic potential?
Cisplatin
Cyclophosphamide
Doxorubicin
Which chemo agents have delayed N/V potential?
Cisplatin
Cyclophosphamide
Carboplatin
Doxorubicin
What is the tx for a moderately or highly emetogenic regimen?
Benzodiazepine for anxiety N/V
5-HT3 antagonist + Dexamethasone + Aprepitant on Day 1
Aprepitant on days 2 and 3
Dexamethasone on days 3 and 4
PRN agent for breakthrough N/V
H2-blocker or PPI
lifestyle measures
What is the tx for a low emetogenic regimen?
Benzodiazepine for anxiety N/V
Dexamethasone or Metoclopromide
PRN agent for breakthrough N/V
H2-blocker or PPI
lifestyle measures
What is the tx for a minimally emetogenic regimen?
Benzodiazepine for anxiety N/V
No antiemetic, unless risk factors are present
PRN agent for breakthrough N/V
H2-Blocker or PPI
lifestyle measures
What are the 5-HT3 antagonists used for antiemetics?
Ondansetron
Granisetron
Dolasetron
Palonesetron (40hr half life = good for acute and delayed N/V)
What are the NK1 receptor antagonists used for antiemetics?
Aprepitant
Fosaprepitant
For acute AND delayed phases
What are the PRN agents used for breakthrough N/V?
Metoclopromide
Prochlorperazine
Promethazine
Droperidol
Dronabinol
Nabilone
What is the MOA of 5-HT3 antagonists?
selectively block 5-HT3 receptors in the GI tract and visceral afferent nerves
What is the MOA of corticosteroids as antiemetics?
unknown
What is the MOA of NK1 receptor antagonists as antiemetics?
binds to neurokinin receptor, inhibiting substance P (implicated in emesis)
What is the MOA of most of the PRN antiemetics?
dopamine receptor blockade in the CTZ
What is the MOA of cannabinoids as PRn antiemetics?
unknown
What are the SE of the 5-HT3 antagonists?
HA
Constipation
mild transaminase increase
What are the SE of corticosteroids as antiemetics?
mood changes
increased appetite
sense of well being
psychosis
What are the SE of NK1 antagonists as antiemetics?
fatigue
HA
hiccups
constipation
anorexia
DI
What are the SE of Metoclopromide PRN antiemesis?
EPSE
sedation
diarrhea
What are the SE of Prochlorperazine and Promethazine PRN antiemesis?
EPSE
sedation
anticholinergic effects
hypotension
What are the SE of Droperidol PRN antiemesis?
Akathisia
Dystonic rxns
sedation
hypotension
What are the SE of cannabinoid PRN antiemesis?
sedation
dry mouth
hunger
orthostatic hypotension
tachycardia
ataxia
dizziness
euphoria
dysphoria
memory loss
Author
giddyupp
ID
67228
Card Set
Chemotherapy Induced Nausea and Vomiting
Description
Chemotherapy Induced Nausea and Vomiting
Updated
2011-02-18T05:57:36Z
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