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IHOP > Cancer-induced N/V (CINV) EXAM 2 > Flashcards

Cancer-induced N/V (CINV) EXAM 2 Flashcards

1
Q

What are the factors that determine the likelihood of N/V?

A

-specific drugs are more likely to cause emeses (Cisplatin)
-dose
-if you use multiple drugs
-IVP or CI

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2
Q

Which moderate emetic risk drugs are known to have a high risk for Emesis when given together?

A

Anthracycline + Cyclophosphamide combination

not true for every combination

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3
Q

What is the emetic risk for most monoclonal antibodies used in cancer treatment?

A

low or minimal emergetic

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4
Q

What is the definition of acute emesis?

A

within 24h (peak = 4-6h)

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5
Q

What is the definition of delayed emesis?

A

after 1-5 days (peaks 2-3d)

caused by
-Cisplatin
-Carboplatin
-Oxoplatin

-Cyclophosphamide
-Ifosfamide

-doxorubicin (also other anthracyclines, daunorubicin etc.)

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6
Q

What is the best way to treat Anticipatory emesis?

A

anxiolytics

-bc they had poor anti-emetic control at the first time, now the anxiety causes the nausea

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7
Q

What is breakthrough emesis?

A

emesis despite optimal CINV prophylaxis
-> need to add Mr drugs

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8
Q

Risk factors for CINV

A

prior emetic control
-anxiety, depression
-women > men
-children> adults

-EtOH abuse are less likely to have CINV

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9
Q

What is the pathophysiology of vomiting induced by chemotherapy?

A

-peripheral release of 5-HT3 and NK-1

-stimulation of 5-HT3 and NK-1 receptors in the brain (CTZ and brain stem)

-autonomic response -> Vomiting

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10
Q

Which cells in the GI release 5-HT3 during cancer treatment?

A

enterochromaffin cells

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11
Q

What is the primary mediator in acute CINV?

A

-Serotonin
-also NK-1

Blocking serotonin helps with acute N/B but not delayed vomiting

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12
Q

Which mediator is improtant for delayed vomiting in cancer therapy?

A

NK-1

also works for acute emesis

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13
Q

What are the common 5-HT3 and NK-1 antagonists used for CINV?

A

5-HT3 antagonist: Ondansetron

NK-1 antagonist: Aprepitant

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14
Q

What are the main antiemetic drugs?

A

-Corticosteroids
-5HT3 antagonists
-Dopamine antagonists
-Olanzapine (D2 antagonist and serotonin antagonist)
-NK-1 inhibitors

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15
Q

What is a common side effect of 5-HT3 antagonists?

A

-headache

-ECG changes (QT prolongation) higher risk with > 8 mg given IVP
for 8 mg we give continuous infusion over 15 min
-no QTc with Palonosetron

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16
Q

Where in the body do 5-HT3 antagonists work?

A

-Peripheral (GI): blocking 5-HT3 release from enterochromaffin cells

-central (brain): blocking 5-HT3 receptors in the medulla

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17
Q

How is Ondansetron metabolized?

A

CYP 2D6
will not work well with ultra metabolizer -> change to Palonosetron (Aloxi)

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18
Q

What is the brand name of Ondanstron?

A

Zofran

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19
Q

What is the brand name of Palonosetron

A

Aloxi

20
Q

Which of the 5-HT3 has the longest half-life?

A

Palonosetron

works better for delayed N/V than Ondansetron

dexamethasone and prochlorperazine (dopamine antagonist) also work better for delayed N/V than Ondansetron

21
Q

Which drug has a synergistic effect when taken with other antiemetics?

A

corticosteroids (add to 5-HT3 antagonists like Zofran)

-BEST for delayed CINV
-synergistic with 5-HT3 -> helps with acute N/V as well

MOA unknown

22
Q

What are the side effects associated with corticosteroids?

A

-euphoria
-insomnia
-hyperglycemia
-immunosuppression (with long-term use)

23
Q

What is the brand name of dexamethasone?

A

Decadron

24
Q

What is the maximum dose of dexamethasone for antiemetic therapy?

A

may 20 mg

25
Q

Which Drug interactions are associated with NK-1 inhibitors?

A

-Fosaprepitant and aprepitant are CYP 3A4 inhibitors

-Rolapitant is a CYP2D6 inhibitor

26
Q

Which NK-1 combi for delayed N/V?

A

-Neutpitant + palonosetron
long halflife
expensive

-Rolapitant
long halflife

27
Q

What is the brand name of Fosaprepitant and aprepitant?

A

Emend

28
Q

What is the MOA of Olanzapine?

A

-5-HT2A, 5-HT2C, 5-HT3 antagonist
-Dopamine (1-4) antagonist
-histamine (1) antagonist
-antimuscarinic

somnolence at days 2 to 3

29
Q

What is the brand name of Olanzapine?

A

Zyprexa

30
Q

What is the dose range of Olanzapine for CINV?

A

5-10 mg PO, Days 1-4

Day 1 for acute N/V
Day 2-4 to prevent delayed N/V

31
Q

What is the drug of choice for anticipatory CINV?

A

Lorazepam (Ativan)

others: Diazepam (Valium)

32
Q

What is the MOA of Prochlorperazine?

A

dopamine receptor antagonist

works for breakthrough CINV

33
Q

What is the brand name of prochlorperazine?

A

Compazine

34
Q

What is the brand name of Promethazine?

A

Phenergan

35
Q

What are the side effects of prochlorperazine and promethazine?

A

-sedation
-hypotension
-anticholinergic
-EPS
-QTc prolongation !!!

36
Q

Name another Dopamine antagonist that is sometimes used for CINV.

A

-Haloperidol
-Droperidol

37
Q

What is the role of Cannabinoids in cancer therapy?

A

chronic N/V from cancer and cachexia weight loss

38
Q

What are the options for acute, delayed and breakthrough N/V?

A

for acute:
-5-HT3
-NK-1
-steroid in combi
-Olanzapine

for delayed N/V:
-NK-1
-steroid with NK-1
-Olanzapine?

for breakthrough N/V:
-phenothiazine is BEST
-Haloperidol (2nd line)
-NK-1
-corticosteroid

39
Q

A woman receives Moderately Emetogenic Chemo (MEC). She has a history of anxiety and depression and had N/V during her last pregnancy.
Design a CINV regimen.

A

for MEC we give 2-3 drugs + breakthrough meds PRN

this patient has a higher risk for N/V so we give 3-4 drugs + PRN

Acute: Ondansetron (5-HT-3)
Delayed: Aprepitant (Emend, NK-1)
Acute and delayed: Olanzapine
Acute and Delayed: Dexamethasone
PRN for home: Prochlorperazine (caution QTc)

40
Q

What is the dose of dexamethasone on day 1 when aprepitant, fosaprepitant or netupitant is part of the regimen for Cisplatin?

A

12 mg (instead of 20 mg) on day 1

we reduce the dose bc of CYP3A4 inhibition of aprepitant

on day 2: 8 mg or 8 mg BID (depending on the NK-1)

41
Q

What is the dose of Aprepitant on day 1 and day 2 and 3?

A

day 1: 125 mg

day 2 and 3: 80 mg

42
Q

What is the dose of Fosaprepitant for CINV?

A

150 mg IV only day 1

(the CYP 3A4 interaction lasts until day 2)

43
Q

What is the dose of Netupitant for CINV?

A

300 mg PO day 1

44
Q

What is the dose of Rolapitant for CINV?

A

180 mg PO day 1

no CYP3A4 inhibition

45
Q

Which drugs are known to cause delayed N/V?
How should Dexamethasone be used for these drugs in a moderate-risk cocktail?

A

-doxorubicin
-cyclophosphamide
-oxaliplatin

consider using dexamethasone 8 mg on days 1, 2, and 3
(usually dexamethasone is only given on day 1 for moderate risk cocktails)

46
Q

Which drugs counteract Parkinson’s disease medication?

A

in Parkinson’s we use dopamine agonists

-dopamine antagonists can make Parkinson’s worse
Olanzapine
Prochlorperazine
Promethazine
Haloperidol

-consider THC, ginger, peppermint, acupuncture

IHOP (13 decks)

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