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

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Chemotherapy Induced Nausea and Vomiting

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Chemotherapy Induced Nausea and Vomiting

Updated

2011-02-18T05:57:36Z

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