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Oncology > CINV > Flashcards

CINV Flashcards

1
Q

What are complications of CINV?

A

Electrolyte imbalance
Dehydration
Malnutrition/ anorexia
Aspiration pneumonia
Rib fractures
Increased intracranial pressure
Mallory-Weiss tears
Wound dehiscence
Degeneration of self-care

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2
Q

Who is at increased risk of CINV?

A

<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

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3
Q

Who is at decreased risk of CINV?

A

Chronic alcohol consumption
>50 y/o

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4
Q

What does emesis potential vary with?

A

Drug, Dose, Infusion time, Route of administration

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5
Q

Which chemo agent has the highest incidence of CINV?

A

Cisplatin

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6
Q

What is the mechanism of CINV?

A

5HT-3 is released from GI tract
CTZ receives stimuli
CTZ releases dopamine and NK1
VC receives stimuli and activates vomiting reflex

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7
Q

What is acute CINV?

A

Occurs within a few minutes to several hours after chemo; resolves within 24 hours; 5HT mediated

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8
Q

What is delayed CINV?

A

Occurs 1-5 days after chemo; can last 7-10 days after chemo; dopamine mediated

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9
Q

What is breakthrough CINV?

A

N/V despite prophylaxis; requires rescue antiemetics

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10
Q

What is anticipatory CINV?

A

Associated with prior unpleasant experiences; psychological

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11
Q

What is refractory CINV?

A

Occurs when all appropriate therapy has failed; usually caused by the tumor

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12
Q

When are antiemetics started for acute CINV?

A

before chemo begins, continued for 24 hours after chemo has ended

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13
Q

What agents are used for acute CINV?

A

Serotonin receptor antagonist +
corticosteroid
+/- NK1 receptor antagonist

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14
Q

What are the 5HT-3 receptor antagonists?

A

Ondansetron
Granisetron
Dolasetron
Palonosetron

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15
Q

What 5HT-3 receptor antagonist has the longest half life, ~40h?

A

Palonosetron (Aloxi)

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16
Q

Which 5HT-3 recptor antagonist can be given IV?

A

Palonosetron (Aloxi)

17
Q

What corticosteroid is most commonly used?

A

Dexamethasone

18
Q

What agents are NK1 receptor antagonists?

A

Aprepitant
Fosaprepitant
Netupitant
Rolapitant

19
Q

What interactions are seen with Aprepitant and Fosaprepitant?

A

Induces CYP2C9
Substrate, inducer, and inhibitor of CYP3A4

20
Q

What is the role of Olanzapine in CINV?

A

acute and delayed CINV

21
Q

How does Olanzapine work to treat CINV?

A

blocks dopamine and serotonin

22
Q

What is the rare adverse effect of Olanzapine?

A

myelosuppression

23
Q

How long should prophylaxis continue after completion of chemo for delayed CINV?

A

2-3 days after

24
Q

What agent is most commonly used to prevent delayed CINV?

A

Dexamethasone

25
Q

Why are serotonin antagonists not the first option for delayed CINV?

A

use beyond 24 hours after chemo is not supported in guidelines

26
Q

How is breakthrough CINV treated?

A

Prevent
Give additional “rescue” agents
Scheduled around-the-clock dosing

27
Q

What agents are added to treat breakthrough CINV?

A

dopamine antagonists

28
Q

What agents are used for anticipatory CINV?

A

short-acting Benzodiazepines

29
Q

What additional agents are used for refractory CINV?

A

Cannabinoids
Olanzapine (if not used previously)

30
Q

What are the ADEs of phenothiazines (prochlorperazine, promethazine)?

A

Sedation
Restlessness
Anticholinergic effects
EPS

31
Q

What are ADEs with Metoclopramide?

A

DIARRHEA
Akathesia/ restlessness
EPS

32
Q

What are ADEs with Olanzapine?

A

Sedation
Dizziness
EPS
Hyperglycemia

33
Q

What are ADEs with NK1 receptor antagonists?

A

Fatigue
Constipation
Hiccups
Dyspepsia

34
Q

What are ADEs with Dexamethasone?

A

Insomnia/ restlessness
Mood swings/ euphoria
Water retention
Increased appetite
Hyperglycemia

35
Q

What are ADEs with serotonin receptor antagonists?

A

Headache
Dizziness
Liver enzyme elevation
Cardiac effects- QT prolongation, torsades

Oncology (22 decks)

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