Chemotherapy Induced Nausea/Vomiting Flashcards
List the complications of nausea/vomiting. (4)
dehydration; electrolyte imbalance; fatigue; depression
Definition: a learned response conditioned by previous emetic reactions to chemotherapy
Anticipatory N/V
Definition: emetic response occuring within 24 hours of receiving chemotherapy
Acute N/V
Definition: emetic response occuring more than 24 hours after last dose of chemotherapy
Delayed N/V
Definition: emetic response that occurs even if taking scheduled anti-emetics prior to chemotherapy
Breakthrough N/V
Definition: nausea/vomitting that persists while on anti-emetic therapy
Refractory N/V
Definition: an inclination to vomit; a feeling in the throat or epigastric region alerting the individual that vomiting may occur
Nausea
Definition: labored movement of abdominal and thoracic muscles before vomitting
Wretching
Definition: the ejection of gastric contents through the mouth
Vomiting
What are the two main targets of anti-emetic medications?
serotonin; substance P
Name a highly emetogenic chemotherapy drug.
cisplatin
List risk factors for chemotherapy induced nausea/vomiting. (6)
female; younger age; history of motion sickness; history of morning sickness; previous CINV; anxiety/anticipation of nausea
Name a factor that can be protective against CINV.
chronic ethanol intake
What are some common toxicities of serotonin antagonists? (3)
headache; prolonged QT interval; constipation
What are some common toxicities of short-term corticosteroids? (3)
insomnia; increased appetite; hyperglycemia
What is the main concern with NK-1 antagonists?
drug interactions - metabolized by CYP3A4
What are some common toxicities of phenothiazines? (1)
sedation
What are some common toxicities of Benzodiazepines? (2)
sedation; urinary incontinence
What are some common toxicities of anticholinergic agents? (4)
salivation; lacrimation; urination; defecation
What two medications are always prescribed for a highly emetogenic regimen?
Steroid (dexamethasone) & serotonin antagonist (ondansetron, etc.)
How many agents should be included in a highly emetogenic regimen?
3 or 4
What agents can be added to a highly emetogenic regimen? (other than the two mainstays of treatment)
NK-1 antagonists (aprepitant) & atypical antipsychotics (olanzapine)
How many agents should be included in a moderate emetogenic regimen?
2 or 3
How many agents should be included in a low emetogenic regimen?
1
What options are there for a low emetogenic regimen? (4)
dexamethasone; metoclopramide; prochlorperazine; 5-HT3 antagonists
What can be used to prevent EPS (extra pyrimadal symptoms) due to metoclopramide or prochlorperazine? (2)
benztropine or diphenhydramine
What agents can be used for breakthrough N/V? (7)
dopamine receptor antagonists; atypical antipsychotics; phenothiazines; benzodiazepines; serotonin antagonists; steroids; anticholinergics
What agents are commonly used for delayed N/V? (3)
dexamethasone; NK-1 antagonist; olanzapine
What medication is used to prevent anticipatory N/V?
Lorazepam
What agent can be used as preventative therapy for high/moderate emetogenic regimens?
5-HT3 antagonists
What agents can be used as preventative therapy for low emetogenic regimens? (3)
metoclopramide; prochlorperazine; 5-HT3 antagonists
What agents can you use to prevent radiation induced emesis?
5-HT3 antagonist +/- dexamethasone
When should anti-emetics be administered?
5 to 30 minutes prior to chemotherapy
What patients should be given PRN anti-emetics to take home after chemotherapy?
ALL OF THEM
