Chemoptherapy Induced Nausea Flashcards
Moderately emetogenic
Carboplatin Ifosfamide Irinitecan Melphalan Cyclophosphamide
Highly emetogeni agents
Cisplatin Cyclophosphamide Mechlorethamine Streptozocin Anthracyclines
Risk factors
Female
<50
Dehydration
History of motion sickness or n/v with past regimens
Highly emetogenic agents
Alkylating Agents significant: Cisplatin-Platinol Carmustine Cyclophosphamide- Cytoxan >1,500mg/meter squared mechlorethamine streptozocin
Moderately emetogenic agents
Anthracyclines Platinum agents irinotecan cyterabine- Ara-C >1,000mg/meter squared cyclophosphamide-Cytoxin <1,500mg/meter squared
Low emetogenic agents
Antimetabolites
Taxanes
liposomal Adriamycin
Vinca Alkaloids
Preventative therapy options
Single Therapy with:
Dexamethasone: x4days starting day before
5HT3 agent
substance P/NK-1 antagonist
What is the definition of Delayed Emesis & how is it managed?
emesis 24hrs after chemotherapy
-use preventative therapy with single or combo therapy based on the agent
High emetogenic management options
steroid + 5HT3 + substance P/NK-1 antagonist
Moderate emetogenic management
steroid + 5HT3
Low emetogenic management
Phenotiazines
What Phenothiazines are used for emesis
Compro-prochlorperazine
Phenergan,Promethagan, Phenadoz-promethazine
Thorazine-chlorpromazine
What is the generic for Compro & Compazine
prochlorperazine
What is the generic for Phenergan, Promethagan, Phenadoz
promethazine
What is the generic for Thorazine
chlorpromazine
What is the mechanism of action of Phenthiazines
Block DA in the CNS & CTZ
Phenothiazines are contraindicated in which group?
children <2
What are the major side effects of Phenothizaines
CNS: EPS, drowsiness, seizures
anticholinergic effects
skin reactions
respiratory depression
What is the max daily dose of Prochloperazine
40mg/day Compazine
25mg/bid Compro (suppository)
What is the minimum age and weight that Compazine or Compro can be used for
2 years & 10kg
What is the antidote for EPS due to Phenothiazines?
Benadryl or Benztropine
use of Phenergan via which rout is contraindicated?
SQ & intra-areterial
Phenergan can cause damage to what system no matter the route of administration?
Tissue damage including gangrene
Which 5HT3 antagonist is best for CINV 7 why
Sancuso patch (granisetron) because it last for 7 days
What is the half life of Aloxil (palonestron)
40 hours
When is the Sancso patch applied
1 day before
A patient has CINV and the physician would like to start kytril IV is this appropriate and why?
No, Kytril is granisetron and granisetron is contraindicated IV for CINV.
Emend is what class of anti-emetic
substance P/NK-1 receptor antagonist
major side effect of Emend
hiccups
Typical dose of Emend
125mg day 1, then80mg/d xday2-4
A stat order comes to the pharmacy for Emend 125mg and Decadron 20mg. What would you do?
Don’t fill the order as is. Need to decrease Decadron (dexamethasone) 20mg to 12mg, as Emend increase the AUC of dexamenthasone.
A patient is to start a highly emetogenic therapy what regimen is recommended?
Day 1: Emend 125mg + Zofran 16-24mg + Decadron 12mg
Day 2-3: Emend 80mg + Decadron 12mg
Day 4: Decadron 10-20mg
