Chemoptherapy Induced Nausea

Question 0

Moderately emetogenic

Answer 0

Carboplatin 
Ifosfamide
Irinitecan
Melphalan
Cyclophosphamide

Question 1

Highly emetogeni agents

Answer 1

Cisplatin
Cyclophosphamide 
Mechlorethamine
Streptozocin
Anthracyclines

Question 2

Risk factors

Answer 2

Female
<50
Dehydration
History of motion sickness or n/v with past regimens

Question 4

Highly emetogenic agents

Answer 4

Alkylating Agents significant:
Cisplatin-Platinol
Carmustine
Cyclophosphamide- Cytoxan >1,500mg/meter squared
mechlorethamine
streptozocin

Question 5

Moderately emetogenic agents

Answer 5

Anthracyclines
Platinum agents
irinotecan
cyterabine- Ara-C >1,000mg/meter squared
cyclophosphamide-Cytoxin <1,500mg/meter squared

Question 6

Low emetogenic agents

Answer 6

Antimetabolites
Taxanes
liposomal Adriamycin
Vinca Alkaloids

Question 7

Preventative therapy options

Answer 7

Single Therapy with:
Dexamethasone: x4days starting day before
5HT3 agent
substance P/NK-1 antagonist

Question 8

What is the definition of Delayed Emesis & how is it managed?

Answer 8

emesis 24hrs after chemotherapy

-use preventative therapy with single or combo therapy based on the agent

Question 9

High emetogenic management options

Answer 9

steroid + 5HT3 + substance P/NK-1 antagonist

Question 10

Moderate emetogenic management

Answer 10

steroid + 5HT3

Question 11

Low emetogenic management

Answer 11

Phenotiazines

Question 12

What Phenothiazines are used for emesis

Answer 12

Compro-prochlorperazine
Phenergan,Promethagan, Phenadoz-promethazine
Thorazine-chlorpromazine

Question 13

What is the generic for Compro & Compazine

Answer 13

prochlorperazine

Question 14

What is the generic for Phenergan, Promethagan, Phenadoz

Answer 14

promethazine

Question 15

What is the generic for Thorazine

Answer 15

chlorpromazine

Question 16

What is the mechanism of action of Phenthiazines

Answer 16

Block DA in the CNS & CTZ

Question 17

Phenothiazines are contraindicated in which group?

Answer 17

children <2

Question 18

What are the major side effects of Phenothizaines

Answer 18

CNS: EPS, drowsiness, seizures
anticholinergic effects
skin reactions
respiratory depression

Question 19

What is the max daily dose of Prochloperazine

Answer 19

40mg/day Compazine

25mg/bid Compro (suppository)

Question 20

What is the minimum age and weight that Compazine or Compro can be used for

Answer 20

2 years & 10kg

Question 21

What is the antidote for EPS due to Phenothiazines?

Answer 21

Benadryl or Benztropine

Question 22

use of Phenergan via which rout is contraindicated?

Answer 22

SQ & intra-areterial

Question 23

Phenergan can cause damage to what system no matter the route of administration?

Answer 23

Tissue damage including gangrene

Question 24

Which 5HT3 antagonist is best for CINV 7 why

Answer 24

Sancuso patch (granisetron) because it last for 7 days

Question 25

What is the half life of Aloxil (palonestron)

Answer 25

40 hours

Question 26

When is the Sancso patch applied

Answer 26

1 day before

Question 27

A patient has CINV and the physician would like to start kytril IV is this appropriate and why?

Answer 27

No, Kytril is granisetron and granisetron is contraindicated IV for CINV.

Question 28

Emend is what class of anti-emetic

Answer 28

substance P/NK-1 receptor antagonist

Question 29

major side effect of Emend

Answer 29

hiccups

Question 30

Typical dose of Emend

Answer 30

125mg day 1, then80mg/d xday2-4

Question 31

A stat order comes to the pharmacy for Emend 125mg and Decadron 20mg. What would you do?

Answer 31

Don’t fill the order as is. Need to decrease Decadron (dexamethasone) 20mg to 12mg, as Emend increase the AUC of dexamenthasone.

Question 32

A patient is to start a highly emetogenic therapy what regimen is recommended?

Answer 32

Day 1: Emend 125mg + Zofran 16-24mg + Decadron 12mg
Day 2-3: Emend 80mg + Decadron 12mg
Day 4: Decadron 10-20mg