Chemo N/V Flashcards
Factors Affecting N/V
- Age
- Sex
- Pre-tx nausea
- Amount of alcohol
- Tx related factors (like dose)
Mechanism of Action
- Generation of free radicals and release of 5-HT which binds to 5-HT3 receptors on vagal afferent fibers
High Risk Chemo Drugs
- Cisplatin
- Cyclophosphamide
Moderate Risk Chemo Drugs
- Doxorubicin
- Daunorubucin
- Carboplatin
- Ifosfamide
Low Risk Chemo Drugs
- Paclitaxel
- Methotrexate
- Docetaxel
Minimal Risk Chemo Drugs
- Bevacizumab
- Rituximab
Serotonin (5-HT) Antagonists
- Ondansetron (Zofran)
- Dolasetron (Anzemet)
- Granisetron (Granisol)
- Palonosetron (Aloxl), longer half life, 40hrs
Serotonin Side Effects
- QT prolongation (monitor patients if they are taking these meds with fluorouquinolone and azithromycin)
What should you do before initiating serotonin antagonists?
Correct hypokalemia and hypomagnesemia
Corticosteroids
- Dexamethasone
- Methylprednisolone (depo-medrol)
Neurokinin 1 Receptor Antagonist
- Aprepitant (EMEND)
MOA of Neurokinin 1 Receptor Antagonist
- Passes through the BBB to bind substance P and NK receptor
- Co-administered with dexamethasone and zofran to prevent chemo induced N/V
Benzodiazepine
- Lorazepam (ativan)
Usually used for anticipatory N/V
Dopamine Receptor Antagonist
- Metoclopramide (reglan)
MOA of Dopamine receptor antagonist
- Stimulates Ach release in the myenteric plexus
- Acts on chemoreceptor triggers in the floor of 4th ventricle which provides important anti-emetic activity
Dopamine receptor antagonist side effects
- EPS (dystonic rxn)
- Sedation
- Restlessness
- Fatigue
Phenothiazines
- Promethazine (phenergan)
- Prochlorperazine (compazine)
MOA of phenothiazines
- Blocks H1 receptors w/out inhibiting histamine release (phenergan)
- Inhibits chemo trigger zone (compazine)
Cannabinoids
- Dronabinol (Marinol)
- Nabilone (cesamet)
Acute Nausea and Vomiting
Initial 24 hrs after getting chemotherapy
Delayed Nausea and Vomiting
Later than 24 hrs after chemotherapy
Anticipatory Nausea and Vomiting
Days to hours before chemotherapy
What antiemtics do you give to a pt with a acute N/V with high emetogenic potential?
Serotonin antagonist +
Corticosteroid +
Aprepitant
What do you give to a pt with acute N/V with moderate emetogenic potential?
Serotonin Antagonist +
Corticosteroid
What do you give to a pt with acute N/V with low emetogenic potential?
A single agent like a corticosteroid
What do you give to a pt with delayed N/V with high emetogenic potential?
Corticosteroid +
Aprepitant
What do you give to a patient with delayed N/V with moderate emetogenic potential?
Corticosteroid OR
Serotonin Antagonist
