CINV Flashcards
What are complications of CINV?
Electrolyte imbalance
Dehydration
Malnutrition/ anorexia
Aspiration pneumonia
Rib fractures
Increased intracranial pressure
Mallory-Weiss tears
Wound dehiscence
Degeneration of self-care
Who is at increased risk of CINV?
<50 y/o
Female
GI, mouth, brain tumor
Cocominant radiation
History of GI distress, motion sickness, morning sickness
Emesis with prior chemo
Multiple cycles of chemo
Who is at decreased risk of CINV?
Chronic alcohol consumption
>50 y/o
What does emesis potential vary with?
Drug, Dose, Infusion time, Route of administration
Which chemo agent has the highest incidence of CINV?
Cisplatin
What is the mechanism of CINV?
5HT-3 is released from GI tract
CTZ receives stimuli
CTZ releases dopamine and NK1
VC receives stimuli and activates vomiting reflex
What is acute CINV?
Occurs within a few minutes to several hours after chemo; resolves within 24 hours; 5HT mediated
What is delayed CINV?
Occurs 1-5 days after chemo; can last 7-10 days after chemo; dopamine mediated
What is breakthrough CINV?
N/V despite prophylaxis; requires rescue antiemetics
What is anticipatory CINV?
Associated with prior unpleasant experiences; psychological
What is refractory CINV?
Occurs when all appropriate therapy has failed; usually caused by the tumor
When are antiemetics started for acute CINV?
before chemo begins, continued for 24 hours after chemo has ended
What agents are used for acute CINV?
Serotonin receptor antagonist +
corticosteroid
+/- NK1 receptor antagonist
What are the 5HT-3 receptor antagonists?
Ondansetron
Granisetron
Dolasetron
Palonosetron
What 5HT-3 receptor antagonist has the longest half life, ~40h?
Palonosetron (Aloxi)
Which 5HT-3 recptor antagonist can be given IV?
Palonosetron (Aloxi)
What corticosteroid is most commonly used?
Dexamethasone
What agents are NK1 receptor antagonists?
Aprepitant
Fosaprepitant
Netupitant
Rolapitant
What interactions are seen with Aprepitant and Fosaprepitant?
Induces CYP2C9
Substrate, inducer, and inhibitor of CYP3A4
What is the role of Olanzapine in CINV?
acute and delayed CINV
How does Olanzapine work to treat CINV?
blocks dopamine and serotonin
What is the rare adverse effect of Olanzapine?
myelosuppression
How long should prophylaxis continue after completion of chemo for delayed CINV?
2-3 days after
What agent is most commonly used to prevent delayed CINV?
Dexamethasone
Why are serotonin antagonists not the first option for delayed CINV?
use beyond 24 hours after chemo is not supported in guidelines
How is breakthrough CINV treated?
Prevent
Give additional “rescue” agents
Scheduled around-the-clock dosing
What agents are added to treat breakthrough CINV?
dopamine antagonists
What agents are used for anticipatory CINV?
short-acting Benzodiazepines
What additional agents are used for refractory CINV?
Cannabinoids
Olanzapine (if not used previously)
What are the ADEs of phenothiazines (prochlorperazine, promethazine)?
Sedation
Restlessness
Anticholinergic effects
EPS
What are ADEs with Metoclopramide?
DIARRHEA
Akathesia/ restlessness
EPS
What are ADEs with Olanzapine?
Sedation
Dizziness
EPS
Hyperglycemia
What are ADEs with NK1 receptor antagonists?
Fatigue
Constipation
Hiccups
Dyspepsia
What are ADEs with Dexamethasone?
Insomnia/ restlessness
Mood swings/ euphoria
Water retention
Increased appetite
Hyperglycemia
What are ADEs with serotonin receptor antagonists?
Headache
Dizziness
Liver enzyme elevation
Cardiac effects- QT prolongation, torsades
