Chemotherapy Induced Nausea/Vomiting Flashcards

1
Q

List the complications of nausea/vomiting. (4)

A

dehydration; electrolyte imbalance; fatigue; depression

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2
Q

Definition: a learned response conditioned by previous emetic reactions to chemotherapy

A

Anticipatory N/V

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3
Q

Definition: emetic response occuring within 24 hours of receiving chemotherapy

A

Acute N/V

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4
Q

Definition: emetic response occuring more than 24 hours after last dose of chemotherapy

A

Delayed N/V

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5
Q

Definition: emetic response that occurs even if taking scheduled anti-emetics prior to chemotherapy

A

Breakthrough N/V

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6
Q

Definition: nausea/vomitting that persists while on anti-emetic therapy

A

Refractory N/V

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7
Q

Definition: an inclination to vomit; a feeling in the throat or epigastric region alerting the individual that vomiting may occur

A

Nausea

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8
Q

Definition: labored movement of abdominal and thoracic muscles before vomitting

A

Wretching

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9
Q

Definition: the ejection of gastric contents through the mouth

A

Vomiting

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10
Q

What are the two main targets of anti-emetic medications?

A

serotonin; substance P

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11
Q

Name a highly emetogenic chemotherapy drug.

A

cisplatin

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12
Q

List risk factors for chemotherapy induced nausea/vomiting. (6)

A

female; younger age; history of motion sickness; history of morning sickness; previous CINV; anxiety/anticipation of nausea

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13
Q

Name a factor that can be protective against CINV.

A

chronic ethanol intake

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14
Q

What are some common toxicities of serotonin antagonists? (3)

A

headache; prolonged QT interval; constipation

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15
Q

What are some common toxicities of short-term corticosteroids? (3)

A

insomnia; increased appetite; hyperglycemia

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16
Q

What is the main concern with NK-1 antagonists?

A

drug interactions - metabolized by CYP3A4

17
Q

What are some common toxicities of phenothiazines? (1)

A

sedation

18
Q

What are some common toxicities of Benzodiazepines? (2)

A

sedation; urinary incontinence

19
Q

What are some common toxicities of anticholinergic agents? (4)

A

salivation; lacrimation; urination; defecation

20
Q

What two medications are always prescribed for a highly emetogenic regimen?

A

Steroid (dexamethasone) & serotonin antagonist (ondansetron, etc.)

21
Q

How many agents should be included in a highly emetogenic regimen?

A

3 or 4

22
Q

What agents can be added to a highly emetogenic regimen? (other than the two mainstays of treatment)

A

NK-1 antagonists (aprepitant) & atypical antipsychotics (olanzapine)

23
Q

How many agents should be included in a moderate emetogenic regimen?

A

2 or 3

24
Q

How many agents should be included in a low emetogenic regimen?

A

1

25
Q

What options are there for a low emetogenic regimen? (4)

A

dexamethasone; metoclopramide; prochlorperazine; 5-HT3 antagonists

26
Q

What can be used to prevent EPS (extra pyrimadal symptoms) due to metoclopramide or prochlorperazine? (2)

A

benztropine or diphenhydramine

27
Q

What agents can be used for breakthrough N/V? (7)

A

dopamine receptor antagonists; atypical antipsychotics; phenothiazines; benzodiazepines; serotonin antagonists; steroids; anticholinergics

28
Q

What agents are commonly used for delayed N/V? (3)

A

dexamethasone; NK-1 antagonist; olanzapine

29
Q

What medication is used to prevent anticipatory N/V?

A

Lorazepam

30
Q

What agent can be used as preventative therapy for high/moderate emetogenic regimens?

A

5-HT3 antagonists

31
Q

What agents can be used as preventative therapy for low emetogenic regimens? (3)

A

metoclopramide; prochlorperazine; 5-HT3 antagonists

32
Q

What agents can you use to prevent radiation induced emesis?

A

5-HT3 antagonist +/- dexamethasone

33
Q

When should anti-emetics be administered?

A

5 to 30 minutes prior to chemotherapy

34
Q

What patients should be given PRN anti-emetics to take home after chemotherapy?

A

ALL OF THEM