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444-Oncology and Neurology > Antineoplastic Induced N/V > Flashcards

Antineoplastic Induced N/V Flashcards

1
Q

the vomiting center sends efferent impulses to the _____, ___, ____, ____

A

salivation center, abdominal muscles, stomach, esophagus

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2
Q

where does the CTZ lie

A

outside the BBB in area postrema of the 4th ventricle

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3
Q

what are the 2 principle neuroreceptors involved in nausea and vomiting

A

dopamine and 5HT

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4
Q

what are the 6 nonprinciple neuroreceptors involved in N/V

A

ACh, corticosteroid, histamine, CB, opioid, NK1

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5
Q

acute AINV occurs within

A

24hrs of chemo

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6
Q

acute AINV peaks at

A

5-6hrs

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7
Q

acute AINV resolves in

A

24hrs

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8
Q

delayed AINV occurs ____

A

24hrs or more after chemo

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9
Q

delayed AINV peaks at _____ and resolves by _____

A

peaks 48-72hrs
lasts 6-7 days

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10
Q

breakthrough AINV is N/V that occurs

A

despite appropriate AINV prophylactic therapy

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11
Q

what type of AINV requires rescue therapy

A

breakthrough therapy

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12
Q

what is a conditioned response that occurs before pts receive their next chemo cycle

A

anticipatory AINV

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13
Q

what is refractory AINV

A

NV that occurs in subsequent cycles where antiemetic prophylaxis and rescue agents have failed in earlier cycles

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14
Q

cisplatin emetic risk

A

high

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15
Q

dacarbazine emetic risk

A

high

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16
Q

anthracycline and cyclophosphamide emetic risk

A

high

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17
Q

carboplatin emetic risk

A

mod

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18
Q

oxaliplatin emetic risk

A

mod

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19
Q

what are some high emetic IV antineoplastics

A

cisplatin
anthracycline + cyclophosphamide
dacarbazine

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20
Q

what are some mod emetic IV antineoplastics

A

carboplatin, oxaliplatn

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21
Q

what increases your risk for AINV

A

female
hx of motion sickness
hx morning sickness
hx AINV

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22
Q

what lowers your risk of AINV

A

> 50yrs
high alcohol consumption

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23
Q

which is easier to treat? vomiting or nausea

A

vomiting

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24
Q

which is easier? to prevent AINV or to treat it

A

prevent

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25
what generation are ondansetron and granisetron
both first gen
26
what gen is palonosetron
2nd gen
27
5HT3RA side effects
constipation QT prolongation
28
which of the following is not used for delayed AINV 1. 5HT3RA 2. NK1RA 3. olanzapine 4. dexamethasone
1- acute only
29
NK1ra SEs
headaches
30
NK1RAs interact with
CYP3A4, 2C9, dex, warfarin, OCs
31
olanzapine AEs
sedation, EPS, orthostatic hypotension, QT interval prolongation
32
dexamethasone SEs
sleep disturbances BG changes mood changes dyspepsia
33
list the meds included in IV high emetic chemo and how often they're included
5HTRAs always NK1RA usually olanzapine sometimes dex usually 3-4 drugs
34
list the meds included in IV med emetic chemo and how often they're included
5HTRAs always NK1RA sometimes olanzapine rarely dex usually 2-3 drugs
35
when should a pt receive 3 antiemetics for a IV-MEC chemo
if using oxaliplatin or carboplatin
36
list the meds included in IV -LEC emetic chemo and how often they're included
5HT3RA usually dex sometimes 1-2 drugs
37
what is the usual dex dose for AINV
8-12mg 30-60min pre (8 for LEC) might have 8mg f2-3d post if mid-high
38
what is the usual dose for ondansetron for AINV
8mg
39
what is the usual dose for granisetron for AINV
2mg
40
what is the usual dose for palonosetron fro AINV
0.5mg
41
what is the usual dose for aprepitant
125mg
42
what is the usual dose for netupitant
300mg
43
wha tis the usual dose for olanzapine
5-10mg f4d
44
list the meds included in PO-HEC/MEC emetic chemo and how often they're included
5HT3RA always included dex sometimes included
45
list the meds included in PO-LEC emetic chemo and how often they're included
individualize decision on 5HT3RA if pt has no AINV for the first 1-2 cycles = can stop 5HT3RA
46
nonpharm measures for breakthrough AINV
eat smaller more frequent meals drink fluids 30 min before food instead of with choose foods that are easy on the stomach eat foods at room temp + avoid mixing hot and cold food avoid foods with strong smell
47
3 pharm choices for breakthrough AINV
metoclopramide prochlorperazine olanzapine
48
metoclopramide MOA
blocks dopamine and 5HT3 receptors on the CTZ
49
metoclopramide AEs
drowsiness, dystonia/ TD, diarrhea
50
metoclopramide DIs
olanzapine and prochlorperazine
51
prochlorperazine MOA
blocks dopamine receptors in CTZ/brain
52
prochlorperazine AEs
constipation, xerostomia, drowsiness, EPS
53
prochlorperazine DIs
caution with olanzapine and other anti-ACh due to fall risk, seizures, and CNS depression
54
olanzapine MOA
5HT, dopamine, H, ACh receptor antagonists
55
olanzapine AEs
sedation, orthostatic hypotension, EPS like sx, caution in elderly
56
what is NMS
life threatening neuro emergency- sx of mental status change, rigidity, fever
57
nonpharm measures for anticipatory AINV
-behavioral therapy -acupuncture or acupressure -prevention is key- optimal prophylaxis critical
58
pharm measures for anticipatory AINV
-Anxiolytics -Lorazepam 0.5-1mg po/sl night before chemo, repeat 1-2hrs pre chemo Don’t drive to chemo
59
what can you do for refractory AINV
escalate prophylactic regimen cannabinoids other agents like haloperidol, scopolamine, H2 antagonists (if GERD element)
60
what role does cannabis play in AINV
small role in breakthrough- second line mod role in refractory
61
usual dose of cananbinoids for AINV
nabilone 1-2mg PO BID prn

444-Oncology and Neurology (22 decks)

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