CINV Flashcards
What are 6 complications of CINV? (Left side)
- Electrolyte imbalances
- Dehydration
- Malnutrition/ anorexia
- Aspiration pneumonia
- Rib fractures
- Weight gain
What are 4 complications of CINV? (Right side)
- Increased intracranial pressure
- Mallory- Weiss tears
- Wound dehiscence
- Degeneration of self care/ functional status
What are 6 patient risk factors?
- Age <50 years
- Female gender
- Tumors in GI tract, mouth or brain
- History of GI distress, motion sickness or motion sickness
- Poor control of emesis with prior chemotherapy
- Multiple cycles of chemotherapy
What are 2 things that have a decreased risk for CINV?
- Chronic alcohol consumption
- Age > 50 years
What 4 things does emetogenic vary with?
- Drug
- Dose
- Infusion time
- Route of administration
What receives stimuli from the GI Tract?
CTZ
What receives stimuli from the GI Tract and CTZ?
Vomiting Center (VC)
What two centers control vomiting in the medulla?
- CTZ
- VC
What are the 3 NTs involved in CINV?
- Dopamine
- Serotonin
- Neurokinin
What are the 5 major types of CINV?
- Acute
- Delayed
- Breakthrough
- Anticipatory
- Refractory
CINV that peaks in 4-10 hours and resolves in 24 hours?
Acute
What is acute CINV mediated by?
Serotonin
Occurs 1-5 days after chemotherapy and can last 7-10 days after last chemotherapy
Delayed
What is Delayed CINV mediated by?
Dopamine
Nausea or emesis despite adequate prophylaxis
Breakthrough CINV
What does breakthrough CINV require?
Rescue antiemetics
CINV that is associated with a prior unpleasant experience and can occur at any time during chemotherapy
Anticipatory
CINV occurs when all appropriate therapy has failed in prior cycles
Refractory
What is refractory CINV usually caused by?
Tumor in the brain or GI Tract
Antiemetics should start before chemotherapy begins and should cover each __ hr. Period of chemotherapy
24
What antiemetic therapy is used to treat acute CINV?
- Serotonin R antagonists
+ corticosteroids
+/- NK1 R antagonist
What are the 4 5HT-3 antagonists?
- Ondansetron
- Granisetron
- Dolasetron
- Palonosetron
What serotonin antagonist has a prolonged half life?
Palonosetron
What serotonin antagonist is the most effective in preventing in CINV?
Palonosetron
What are the 4 ADRs of serotonin R antagonists?
- Headache
- Dizziness
- Liver enzyme elevations
- Cardiac effects- QT prolongation and torsades de pointes
What should be used in combination with serotonin antagonists?
Corticosteroids
What is the most commonly used corticosteroid?
Dexamethasone
What are the 4 NK1 R antagonists?
- Aprepitant
- Fosaprepitant
- Netupitant
- Rolapitant
What must be used in combination with serotonin antagonist and dexamethasone?
NK1 R antagonists
What are the 4 ADRS of NK1 antagonists?
- Fatigue
- Constipation
- Hiccups
- Dyspepsia
What are drug interactions for aprepitant/ fosaprepitant?
- A substrate, moderate inducer and moderate inhibitor or cyp3A4
- Induces cyp2c9
What drugs would you use for refractory CINV?
- Cannabinoids
- Olanzapine
What is a possible ADR of olanzapine?
Myelosuppression
What agent is most commonly used for prevention of Delayed CINV?
Dexamethasone
What are the 3 dopamine antagonists?
- Metoclopramide
- Phenothiazines
- Butyrophenones
What is the most effective single antiemetic agent prior to the introduction of serotonin antagonists?
Metoclopramide
What are the 3 ADRs of Metoclopramide?
- Diarrhea
- Akathesia
- EPS
What is the treatment of choice for anticipatory CINV?
Benzodiazepines
What are the 2 BZDs used?
- Lorazepam
- Alprazolam
What are the 2 canabinoids that are currently available?
- Dronabinol
- Nabilone
What are the ADRs of the androgen receptor inhibitors?
- Muscle aches
- Fatigue
- Hypertension