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Oncology > CINV > Flashcards

CINV Flashcards

1
Q

What is the MOA of serotonin antagonists?

A

These block serotonin receptors in the:

CNS: CTZ and vagal afferents (5-HT3-receptors)

Periphery: inhibits serotonin release from gastrointestinal tract

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2
Q

What are the generic/brand names of 5-HT3 RAs?

A

Dolasetron (Anzemet)
Granisetron (Kytril)
Ondansetron (Zolfran)
Palonosetron (Aloxil)

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3
Q

Zolfran doses for CINV treatment are:

A

High emotogienticity:
16-24 mg prior to chemo

Moderate: 8 mg PO Q8-12 hrs.

IV: 0.15 mg/kg/dose (MAX 16 mg/dose). Subsequent doses may be repeated 4 and 8 hrs after the 1st dose

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4
Q

When should 5-HT3 RAs be used in CINV?

A

These are standard therapy for highly and moderately emetogenic chemo.
They are used synergistically with corticosteroids.
Oral and IV dosage forms are equally efficacious.
Antiemetic effect > anti-nausea effect

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5
Q

What ADRs are associated with 5-HT3 RA use?

A

Generally well tolerated.
Common: HA, constipation
Severe: QTc prolongation

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6
Q

When should dexamethasone (Decadron) be used for CINV?

A

Not effective as monotherapy for highly or moderately emetogenic regimens.
Very effective in preventing delayed CINV due to synergistic effects.

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7
Q

ADRs associated with Decadron are:

A 
Insomnia
Anxiety
Increased appetite
Rise in blood glucose levels
Many many more
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8
Q

What is the MOA is NK1 antagonists?

A

Substance P is a neuropeptide which binds to NK1 receptor in abdominal afferent vagal nerves and CTZ resulting in emesis.

NK1 antagonists have high-affinity for human substance P/NK1 receptors.

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9
Q

NK1 antagonists cause which ADRs?

A 
Hiccups
Dyspepsia
Constipation
Diarrhea
HA
Fatigue
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10
Q

What agents are NK1 antagonists?

A

Aprepitant (Emend)
Fosaprepitant (Emend for injection)
Netupitant/palonosetron (Akynzeo)
Rolapitant (Varubi)

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11
Q

When are BZDs used in CINV?

A

Anticipatory and breakthrough CINV

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12
Q

Which BZD is commonly used in CINV?

A

Lorazepam (Ativan)
0.5-2 mg PO/IV/SL Q4-6H PRN
Max 2 mg/dose

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13
Q

ADRs caused by BZD use are:

A

Sedation
Amnesia
Dizziness
Unsteadiness

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14
Q

What is the MOA of phenothiazines?

A

Blockade of dopamine receptors in the CTZ

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15
Q

When are phenothiazines used?

A

Breakthrough treatment of delayed CINV.

Has rapid onset

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16
Q

Which agents are classified as phenothiazines?

A

Prochlorperazine (Compazine)

Promethazine (Phenergan)

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17
Q

ADRs of phenothiazines are:

A

Sedation

EPS

18
Q

What is the MOA of metoclopamide (Reglan)?

A

It’s antiemetic MOA is via inhibition of central and peripheral dopamine receptors.

19
Q

When is Reglan used?

A

Delayed CINV

For higher doses, co-administered with diphenhydramine and lorazepam to prevent EPS

20
Q

ADRs of Reglan are:

A 
EPS
Drowsiness
Restlessness
Fatigue
Diarrhea
21
Q

What is the MOA of olanzapine (Zyprexa)?

A

Blocks dopamine, serotonin, histamine, and acetylcholine.

22
Q

What is the MOA of haloperidol (Haldol)?

A

It is a dopamine receptor antagonist

23
Q

When are antipsychotics used in CINV?

A

Prophylaxis for highly and moderately emetogenic regimens (olanzapine)

As a rescue med for breakthrough CINV

24
Q

What are the ADRs for olanzapine?

A

Disturbed sleep
Fatigue
Drowsiness
Dry mouth

25
Q

ADRs of Haldol include:

A

EPS
Dystonic reactions
HA
QT prolongation (rare)

26
Q

BBW associated with antipsychotics are:

A

Use in caution with elderly patients and dementia: antipsychotics increase risk of mortality

27
Q

Which 2 agents are used to treat EPS?

A

Diphenhydramine and Benztropine

28
Q

What is the MOA of cannabinoids?

A

Direct inhibition of neurotransmitters via agonist of CB1 CNS receptor

29
Q

When are cannabinoids used in CINV?

A

In refractory cases

30
Q

Which agents are cannabinoids?

A

Nabilone (Cesamet)

Dronabinol (Marinol)

31
Q

ADRs associated with cannabinoids are:

A

Sedation
Dysphoria or euphoria
Concentration difficulties
Paranoia

32
Q

What is the MOA of scopolamine transdermal patch (Transdermal Scop)?

A

It is an anticholinergic/antimuscarinic agent. It works in the CNS by blocking cholinergic transmission to the vomiting center.

33
Q

When is scopolamine used in CINV?

A

Refractory CINV associated with motion or dizziness

34
Q

ADRs caused by Transderm Scop used are?

A

Dry mouth
Somnolence
Blurred vision

35
Q

High emetic risk IV agents (>90%) are:

A 
AC (doxorubicin/epirubicin with cyclophosphamide 
Cisplatin
Cyclophosphamide > 1500 mg/m2
Doxorubicin > 60 mg/m2
Ifosfamide >= 2 g/m2
36
Q

Mod emetic risk IV agents (30-90%) are:

A 
Busulfan
Carboplatin
Cyclophosphamide = 1500 mg/m2
Doxorubicin < 60 mg/m2
Irinotecan
Methotrexate >= 250 mg/m2
37
Q

Low emetic risk agents (10-30%) are:

A

Docetaxel
Doxorubicin liposomal
5-FU
Paclitaxel (including albumin bound)

38
Q

Mod to high emetic risk oral agents are:

A

Busulfan >= 4 mg/d
Ceritinib
Crizotinib

39
Q

Min to low emetic risk oral agents are:

A

‘’Nib’’

Capecitabine

40
Q

Patient specific risk factors for CINV are:

A 
Female
< 50 yo
History of motion sickness
Pregnancy-related nausea
Lack of alcohol use
History of anxiety or depression
Prior chemo use

Oncology (6 decks)

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