07 Oncology Chan Flashcards
For the different types of Emesis, what is Anticipatory?
Occurs prior to chemotherapy
For the different types of Emesis, what is Acute Onset?
Occurs several minutes to hours after chemotherapy. Peaks in 5-6 hours and resolves w/in 24 hours after chemotherapy
For the different types of Emesis, what is Delayed onset?
Occurs > 24 hours after chemotherapy
For the different types of Emesis, what is Breakthrough?
Occurs while already on antiemetic therapy. Generally require additional (PRN) antiemetic drug chemotherapy
For the different types of Emesis, what is Refractory?
Occurs when antiemetic therapy fails despite adequate coverage (sometimes observed after multiple cycles of treatment)
What are some patient characteristics and risk factors for Emesis?
Previous episodes of N/V. Age < 50 years. Female. History of motion sickness. High anxiety (anticipatory). History of low alcohol consumption
What are the different drug classes to pick from to help with Emesis?
5HT3 Receptor Antagonists. Steroids. NK-1 Receptor Antagonists. Dopamine Antagonists. Benzodiazepines
When are 5HT3 Receptor Antagonists used?
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
What are the 5HT3 Receptor Antagonists used?
Ondansetron (Zofran). Granisetron (Kytril). Dolasetron (Anzemet). Palonosetron (Aloxi)
Why is Ondansetron IV not recommended?
Causes QT prolongation
Why is Dolasetron (Anzemet) IV not recommended?
Torsades
Which 5HT3 Receptor Antagonist is effective for delayed N/V?
Palonosetron d/t its longer half-life
What are the most common ADRs with 5HT3 Receptor Antagonists?
HA. GI (constipation > diarrhea). QT prolongation (New warning): monitor K/Mag (keep K > 4 and Mag > 1.8)
What is the preferred steroid to be used for chemo induced nausea?
Dexamethasone (Decadron): high potency, long half-life. Can be used mono (low emetogenic), combo (moderate-high emetogenic)
What are the most common ADRs with Dexamethasone (Decadron)?
GI (stomach upset). CNS (insomnia). Labs (monitor increased glucose and WBC)
What is the NK-1 Receptor Antagonist used?
Emend (Aprepitant). Best used for prevention of delayed N/V from moderate to highly emetogenic chemo. Requires a 3 day regimen
What are the most common ADRs with Emend?
GI (stomach upset). Hiccups
What DDI needs to be watched with Emend?
3A4 inhibitor and substrate, 2C9 inducer. DECREASE Dexamethasone dose by 50%
When are Dopamine Receptor Antagonists used for emesis?
Monotherapy for low emetogenic chemo, and adjunctive agents for moderate to highly emetogenic chemo
What are the Dopamine Receptor Antagonists used?
Metoclopramide (Reglan). Prochloperazine (Compazine)
What are the common ADRs seen with Dopamine Receptor Antagonists?
CNS (EPS - dose/frequency dependent, can be managed by using anticholinergic agent). Drowsiness, dizziness, somnolence
How can Benzos (Lorazepam) be used for emesis?
Acts on GABA receptors to produce anxiolytic effects. Primarily for anticipatory N/V. Lorazepam (Ativan) is the preferred benzo d/t short half-life
When is Lorazepam not effective for emesis?
As single agent for treatment or prevention of N/V
What are the commonly observed ADRs with Lorazepam?
CNS (drowsiness, confusion). Respiratory depression (dose dependent). DDI with other CNS depressant agents
When is a medication classified as Highly Emetogenic?
> 90% frequency of emesis without antiemetics
What is the recommended antiemetic treatment?
3 drug regimen: 5HT3 receptor antagonist, Steroid, NK-1 Receptor Antagonist
What are the 3 components to a REMS program?
A medication guide or patient package insert. A communication plan for healthcare providers. Elements to assure safe use
