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Cancer Care > Anti-emetics > Flashcards

Anti-emetics Flashcards

1
Q

Which anti-emetic is indicated for chemotherapy, radiotherapy and post-op GI Surgery?

A

Ondansetron

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2
Q

What is the MoA of ondansetron?

A

Potent serotonin blocker - serotonin receptors are found in the vomiting centre and chemoreceptor trigger zone.

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3
Q

What are the side-effects of ondansetron?

A

Headache, constipation, diarrhoea, dizziness, QT prolongation

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4
Q

Outline the pathophysiology of vomiting

A
  1. Vomiting Centre - fed by autonomic afferents from the gut and higher centres (trigger anticipatory vomiting)
  2. Chemoreceptor trigger zone - toxins in blood was over this and cause vomiting
    3 - VIII nucleus
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5
Q

What molecules act at each structure associated with vomiting?

A

Vomiting Centre - serotonin, histamine, acetylcholine, NK1
Chemoreceptor trigger zone - serotonin, dopamine, NK1
VIII nucleus - histamine, acetylcholine

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6
Q

What the MoA of Haloperidol?

A

Dopamine blocker so only acts at the chemoreceptor trigger zone

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7
Q

For what causes of nausea would you consider prescribing haloperidol and why?

A

Metabolic or drug induced nausea because these toxins was over the chemoreceptor trigger zone which is where haloperidol blocks dopamine receptors.
E.g. hypercalcaemia, renal impairment, iron tablets.

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8
Q

What is the MoA of metoclopramide?

A

Dopamine antagonist and prokinetic (works on emptying the stomach)

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9
Q

In what causes of nausea would you consider prescribing metoclopromide?

A

Gastric stasis and constipation

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10
Q

What is CINV?

A

Chemotherapy induced nausea and vomiting

It includes acute, delayed and anticipatory CINV.

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11
Q

Describe the pathophysiology of CINV

A

Massive release of substance P and serotonin due to cell damage post chemotherapy.

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12
Q

What medications are used to treat CINV?

A

Steroids
Metoclopramide
Ondansetron

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13
Q

What is the MoA of ondansetron?

A

Serotonin blocker

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14
Q

What causes of nausea and vomiting would you use ondansetron for?

A

Chemotherapy and radiotherapy induced N&V

Post GI surgery

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15
Q

What are the side effects of ondansetron?

A 
Headache
Constipation
Diarrhoea
Dizziness
QT prolongation
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16
Q

What is domperidone?

A

D2 antagonist - acts peripherally so no acute dystonic side effects.

17
Q

What is cyclizine?

A

Histamine and acetylcholine antagonist

18
Q

What are the indications for cyclizine?

A

Functional bowel obstruction

Raised ICP

19
Q

What are the side effects of cyclizine?

A 
Sedation
Dry mouth
Dizziness
Hypotension
Tachycardia
20
Q

What non-pharmacological advice can you give to patients to help them with N&V?

A

Smell - avoid cooking
If taste is a trigger, aim for small appropriate meals
Complementary therapy - acupuncture, hypnosis

Cancer Care (16 decks)

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