07 Oncology Chan

Question 1

For the different types of Emesis, what is Anticipatory?

Answer 1

Occurs prior to chemotherapy

Question 2

For the different types of Emesis, what is Acute Onset?

Answer 2

Occurs several minutes to hours after chemotherapy. Peaks in 5-6 hours and resolves w/in 24 hours after chemotherapy

Question 3

For the different types of Emesis, what is Delayed onset?

Answer 3

Occurs > 24 hours after chemotherapy

Question 4

For the different types of Emesis, what is Breakthrough?

Answer 4

Occurs while already on antiemetic therapy. Generally require additional (PRN) antiemetic drug chemotherapy

Question 5

For the different types of Emesis, what is Refractory?

Answer 5

Occurs when antiemetic therapy fails despite adequate coverage (sometimes observed after multiple cycles of treatment)

Question 6

What are some patient characteristics and risk factors for Emesis?

Answer 6

Previous episodes of N/V. Age < 50 years. Female. History of motion sickness. High anxiety (anticipatory). History of low alcohol consumption

Question 7

What are the different drug classes to pick from to help with Emesis?

Answer 7

5HT3 Receptor Antagonists. Steroids. NK-1 Receptor Antagonists. Dopamine Antagonists. Benzodiazepines

Question 8

When are 5HT3 Receptor Antagonists used?

Answer 8

Moderate to highly emetogenic chemotherapy. Effective as mono and combination therapy (usually with steroid). NOT as effective for breakthrough emesis. LESS effective for delayed N/V

Question 9

What are the 5HT3 Receptor Antagonists used?

Answer 9

Ondansetron (Zofran). Granisetron (Kytril). Dolasetron (Anzemet). Palonosetron (Aloxi)

Question 10

Why is Ondansetron IV not recommended?

Answer 10

Causes QT prolongation

Question 11

Why is Dolasetron (Anzemet) IV not recommended?

Answer 11

Torsades

Question 12

Which 5HT3 Receptor Antagonist is effective for delayed N/V?

Answer 12

Palonosetron d/t its longer half-life

Question 13

What are the most common ADRs with 5HT3 Receptor Antagonists?

Answer 13

HA. GI (constipation > diarrhea). QT prolongation (New warning): monitor K/Mag (keep K > 4 and Mag > 1.8)

Question 14

What is the preferred steroid to be used for chemo induced nausea?

Answer 14

Dexamethasone (Decadron): high potency, long half-life. Can be used mono (low emetogenic), combo (moderate-high emetogenic)

Question 15

What are the most common ADRs with Dexamethasone (Decadron)?

Answer 15

GI (stomach upset). CNS (insomnia). Labs (monitor increased glucose and WBC)

Question 16

What is the NK-1 Receptor Antagonist used?

Answer 16

Emend (Aprepitant). Best used for prevention of delayed N/V from moderate to highly emetogenic chemo. Requires a 3 day regimen

Question 17

What are the most common ADRs with Emend?

Answer 17

GI (stomach upset). Hiccups

Question 18

What DDI needs to be watched with Emend?

Answer 18

3A4 inhibitor and substrate, 2C9 inducer. DECREASE Dexamethasone dose by 50%

Question 19

When are Dopamine Receptor Antagonists used for emesis?

Answer 19

Monotherapy for low emetogenic chemo, and adjunctive agents for moderate to highly emetogenic chemo

Question 20

What are the Dopamine Receptor Antagonists used?

Answer 20

Metoclopramide (Reglan). Prochloperazine (Compazine)

Question 21

What are the common ADRs seen with Dopamine Receptor Antagonists?

Answer 21

CNS (EPS - dose/frequency dependent, can be managed by using anticholinergic agent). Drowsiness, dizziness, somnolence

Question 22

How can Benzos (Lorazepam) be used for emesis?

Answer 22

Acts on GABA receptors to produce anxiolytic effects. Primarily for anticipatory N/V. Lorazepam (Ativan) is the preferred benzo d/t short half-life

Question 23

When is Lorazepam not effective for emesis?

Answer 23

As single agent for treatment or prevention of N/V

Question 24

What are the commonly observed ADRs with Lorazepam?

Answer 24

CNS (drowsiness, confusion). Respiratory depression (dose dependent). DDI with other CNS depressant agents

Question 25

When is a medication classified as Highly Emetogenic?

Answer 25

> 90% frequency of emesis without antiemetics

Question 26

What is the recommended antiemetic treatment?

Answer 26

3 drug regimen: 5HT3 receptor antagonist, Steroid, NK-1 Receptor Antagonist

Question 27

What are the 3 components to a REMS program?

Answer 27

A medication guide or patient package insert. A communication plan for healthcare providers. Elements to assure safe use