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PY3 > CINV > Flashcards

CINV Flashcards

1
Q

What are 6 complications of CINV? (Left side)

A
  1. Electrolyte imbalances
  2. Dehydration
  3. Malnutrition/ anorexia
  4. Aspiration pneumonia
  5. Rib fractures
  6. Weight gain
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2
Q

What are 4 complications of CINV? (Right side)

A
  1. Increased intracranial pressure
  2. Mallory- Weiss tears
  3. Wound dehiscence
  4. Degeneration of self care/ functional status
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3
Q

What are 6 patient risk factors?

A
  1. Age <50 years
  2. Female gender
  3. Tumors in GI tract, mouth or brain
  4. History of GI distress, motion sickness or motion sickness
  5. Poor control of emesis with prior chemotherapy
  6. Multiple cycles of chemotherapy
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4
Q

What are 2 things that have a decreased risk for CINV?

A
  1. Chronic alcohol consumption
  2. Age > 50 years
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5
Q

What 4 things does emetogenic vary with?

A
  1. Drug
  2. Dose
  3. Infusion time
  4. Route of administration
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6
Q

What receives stimuli from the GI Tract?

A

CTZ

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7
Q

What receives stimuli from the GI Tract and CTZ?

A

Vomiting Center (VC)

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8
Q

What two centers control vomiting in the medulla?

A
  1. CTZ
  2. VC
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9
Q

What are the 3 NTs involved in CINV?

A
  1. Dopamine
  2. Serotonin
  3. Neurokinin
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10
Q

What are the 5 major types of CINV?

A
  1. Acute
  2. Delayed
  3. Breakthrough
  4. Anticipatory
  5. Refractory
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11
Q

CINV that peaks in 4-10 hours and resolves in 24 hours?

A

Acute

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12
Q

What is acute CINV mediated by?

A

Serotonin

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13
Q

Occurs 1-5 days after chemotherapy and can last 7-10 days after last chemotherapy

A

Delayed

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14
Q

What is Delayed CINV mediated by?

A

Dopamine

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15
Q

Nausea or emesis despite adequate prophylaxis

A

Breakthrough CINV

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16
Q

What does breakthrough CINV require?

A

Rescue antiemetics

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17
Q

CINV that is associated with a prior unpleasant experience and can occur at any time during chemotherapy

A

Anticipatory

18
Q

CINV occurs when all appropriate therapy has failed in prior cycles

A

Refractory

19
Q

What is refractory CINV usually caused by?

A

Tumor in the brain or GI Tract

20
Q

Antiemetics should start before chemotherapy begins and should cover each __ hr. Period of chemotherapy

A

24

21
Q

What antiemetic therapy is used to treat acute CINV?

A
  1. Serotonin R antagonists
    + corticosteroids
    +/- NK1 R antagonist
22
Q

What are the 4 5HT-3 antagonists?

A
  1. Ondansetron
  2. Granisetron
  3. Dolasetron
  4. Palonosetron
23
Q

What serotonin antagonist has a prolonged half life?

A

Palonosetron

24
Q

What serotonin antagonist is the most effective in preventing in CINV?

A

Palonosetron

25
Q

What are the 4 ADRs of serotonin R antagonists?

A
  1. Headache
  2. Dizziness
  3. Liver enzyme elevations
  4. Cardiac effects- QT prolongation and torsades de pointes
26
Q

What should be used in combination with serotonin antagonists?

A

Corticosteroids

27
Q

What is the most commonly used corticosteroid?

A

Dexamethasone

28
Q

What are the 4 NK1 R antagonists?

A
  1. Aprepitant
  2. Fosaprepitant
  3. Netupitant
  4. Rolapitant
29
Q

What must be used in combination with serotonin antagonist and dexamethasone?

A

NK1 R antagonists

30
Q

What are the 4 ADRS of NK1 antagonists?

A
  1. Fatigue
  2. Constipation
  3. Hiccups
  4. Dyspepsia
31
Q

What are drug interactions for aprepitant/ fosaprepitant?

A
  1. A substrate, moderate inducer and moderate inhibitor or cyp3A4
  2. Induces cyp2c9
32
Q

What drugs would you use for refractory CINV?

A
  1. Cannabinoids
  2. Olanzapine
33
Q

What is a possible ADR of olanzapine?

A

Myelosuppression

34
Q

What agent is most commonly used for prevention of Delayed CINV?

A

Dexamethasone

35
Q

What are the 3 dopamine antagonists?

A
  1. Metoclopramide
  2. Phenothiazines
  3. Butyrophenones
36
Q

What is the most effective single antiemetic agent prior to the introduction of serotonin antagonists?

A

Metoclopramide

37
Q

What are the 3 ADRs of Metoclopramide?

A
  1. Diarrhea
  2. Akathesia
  3. EPS
38
Q

What is the treatment of choice for anticipatory CINV?

A

Benzodiazepines

39
Q

What are the 2 BZDs used?

A
  1. Lorazepam
  2. Alprazolam
40
Q

What are the 2 canabinoids that are currently available?

A
  1. Dronabinol
  2. Nabilone
41
Q

What are the ADRs of the androgen receptor inhibitors?

A
  1. Muscle aches
  2. Fatigue
  3. Hypertension

PY3 (24 decks)

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