Chemo N/V

Question 1

Factors Affecting N/V

Answer 1

• Age
• Sex
• Pre-tx nausea
• Amount of alcohol
• Tx related factors (like dose)

Question 2

Mechanism of Action

Answer 2

• Generation of free radicals and release of 5-HT which binds to 5-HT3 receptors on vagal afferent fibers

Question 3

High Risk Chemo Drugs

Answer 3

• Cisplatin

- Cyclophosphamide

Question 4

Moderate Risk Chemo Drugs

Answer 4

• Doxorubicin
• Daunorubucin
• Carboplatin
• Ifosfamide

Question 5

Low Risk Chemo Drugs

Answer 5

• Paclitaxel
• Methotrexate
• Docetaxel

Question 6

Minimal Risk Chemo Drugs

Answer 6

• Bevacizumab

- Rituximab

Question 7

Serotonin (5-HT) Antagonists

Answer 7

• Ondansetron (Zofran)
• Dolasetron (Anzemet)
• Granisetron (Granisol)
• Palonosetron (Aloxl), longer half life, 40hrs

Question 8

Serotonin Side Effects

Answer 8

• QT prolongation (monitor patients if they are taking these meds with fluorouquinolone and azithromycin)

Question 9

What should you do before initiating serotonin antagonists?

Answer 9

Correct hypokalemia and hypomagnesemia

Question 10

Corticosteroids

Answer 10

• Dexamethasone

- Methylprednisolone (depo-medrol)

Question 11

Neurokinin 1 Receptor Antagonist

Answer 11

• Aprepitant (EMEND)

Question 12

MOA of Neurokinin 1 Receptor Antagonist

Answer 12

• Passes through the BBB to bind substance P and NK receptor

- Co-administered with dexamethasone and zofran to prevent chemo induced N/V

Question 13

Benzodiazepine

Answer 13

• Lorazepam (ativan)

Usually used for anticipatory N/V

Question 14

Dopamine Receptor Antagonist

Answer 14

• Metoclopramide (reglan)

Question 15

MOA of Dopamine receptor antagonist

Answer 15

• Stimulates Ach release in the myenteric plexus

- Acts on chemoreceptor triggers in the floor of 4th ventricle which provides important anti-emetic activity

Question 16

Dopamine receptor antagonist side effects

Answer 16

• EPS (dystonic rxn)
• Sedation
• Restlessness
• Fatigue

Question 17

Phenothiazines

Answer 17

• Promethazine (phenergan)

- Prochlorperazine (compazine)

Question 18

MOA of phenothiazines

Answer 18

• Blocks H1 receptors w/out inhibiting histamine release (phenergan)
• Inhibits chemo trigger zone (compazine)

Question 19

Cannabinoids

Answer 19

• Dronabinol (Marinol)

- Nabilone (cesamet)

Question 20

Acute Nausea and Vomiting

Answer 20

Initial 24 hrs after getting chemotherapy

Question 21

Delayed Nausea and Vomiting

Answer 21

Later than 24 hrs after chemotherapy

Question 22

Anticipatory Nausea and Vomiting

Answer 22

Days to hours before chemotherapy

Question 23

What antiemtics do you give to a pt with a acute N/V with high emetogenic potential?

Answer 23

Serotonin antagonist +
Corticosteroid +
Aprepitant

Question 24

What do you give to a pt with acute N/V with moderate emetogenic potential?

Answer 24

Serotonin Antagonist +

Corticosteroid

Question 25

What do you give to a pt with acute N/V with low emetogenic potential?

Answer 25

A single agent like a corticosteroid

Question 26

What do you give to a pt with delayed N/V with high emetogenic potential?

Answer 26

Corticosteroid +

Aprepitant

Question 27

What do you give to a patient with delayed N/V with moderate emetogenic potential?

Answer 27

Corticosteroid OR

Serotonin Antagonist